Provider Demographics
NPI:1760789895
Name:CARTY, JEFFREY ALAN
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:CARTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10358 E CAPERCAILLIE ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-8970
Mailing Address - Country:US
Mailing Address - Phone:520-398-5717
Mailing Address - Fax:
Practice Address - Street 1:10358 E CAPERCAILLIE ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-8970
Practice Address - Country:US
Practice Address - Phone:520-398-5717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2014002385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child