Provider Demographics
NPI:1437184256
Name:TWITCHELL, CAROL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:TWITCHELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 MINEOLA DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6326
Mailing Address - Country:US
Mailing Address - Phone:941-954-1506
Mailing Address - Fax:
Practice Address - Street 1:3507 MINEOLA DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-6326
Practice Address - Country:US
Practice Address - Phone:941-954-1506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4133103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73903Medicare ID - Type Unspecified