Provider Demographics
NPI:1396848032
Name:CARTER, ROY ALLAN (PH D)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:ALLAN
Last Name:CARTER
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 PRESCOTT AVENUE
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-1737
Mailing Address - Country:US
Mailing Address - Phone:607-757-9899
Mailing Address - Fax:607-754-0769
Practice Address - Street 1:202 EAST MAIN STREET
Practice Address - Street 2:SAMARITAN COUNSELING CENTER
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760
Practice Address - Country:US
Practice Address - Phone:607-754-2660
Practice Address - Fax:607-754-0769
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0005211106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist