Provider Demographics
NPI:1942755509
Name:PRATT, CARL JR (MSMHC)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:PRATT
Suffix:JR
Gender:M
Credentials:MSMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 LIVE OAKS BLVD
Mailing Address - Street 2:0605
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-3827
Mailing Address - Country:US
Mailing Address - Phone:407-986-0377
Mailing Address - Fax:
Practice Address - Street 1:109 LIVE OAKS BLVD
Practice Address - Street 2:0605
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-3827
Practice Address - Country:US
Practice Address - Phone:407-986-0377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNONE171M00000X
FLP630139743438172A00000X
FL234582376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172A00000XOther Service ProvidersDriver
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016291000OtherPROVIDER NUMBER