Provider Demographics
NPI:1689245227
Name:CARTER, KYLE (MED, LBS)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:CARTER
Suffix:
Gender:M
Credentials:MED, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 RACE ST STE B
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-1024
Mailing Address - Country:US
Mailing Address - Phone:215-432-2604
Mailing Address - Fax:
Practice Address - Street 1:6601 N GRATZ ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19126-2633
Practice Address - Country:US
Practice Address - Phone:215-432-2604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst