Provider Demographics
NPI:1518963461
Name:TRIPLETT, CARLA R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:R
Last Name:TRIPLETT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 PLAZA ST E
Mailing Address - Street 2:SUITE #1A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-5048
Mailing Address - Country:US
Mailing Address - Phone:347-617-6711
Mailing Address - Fax:347-586-0294
Practice Address - Street 1:36 PLAZA ST E
Practice Address - Street 2:SUITE #1A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-5048
Practice Address - Country:US
Practice Address - Phone:347-617-6711
Practice Address - Fax:347-586-0294
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016206103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical