Provider Demographics
NPI:1922211598
Name:CARR, VIRGINIA COLLEEN (PH D)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:COLLEEN
Last Name:CARR
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 TAMIAMI TRL N
Mailing Address - Street 2:STE 508
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-4456
Mailing Address - Country:US
Mailing Address - Phone:239-262-6700
Mailing Address - Fax:239-262-7364
Practice Address - Street 1:2335 TAMIAMI TRL N
Practice Address - Street 2:STE 508
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4456
Practice Address - Country:US
Practice Address - Phone:239-262-6700
Practice Address - Fax:239-262-7364
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4368103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73789Medicare ID - Type Unspecified