Provider Demographics
NPI:1578672754
Name:GASS, CARLTON SIMPSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARLTON
Middle Name:SIMPSON
Last Name:GASS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1401 CENTERVILLE ROAD
Mailing Address - Street 2:SUITE 504
Mailing Address - City:TALLAHASEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4640
Mailing Address - Country:US
Mailing Address - Phone:850-431-5037
Mailing Address - Fax:850-431-6101
Practice Address - Street 1:1401 CENTERVILLE ROAD
Practice Address - Street 2:SUITE 504
Practice Address - City:TALLAHASEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4640
Practice Address - Country:US
Practice Address - Phone:850-431-5037
Practice Address - Fax:850-431-6101
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPY3758103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist