Provider Demographics
NPI:1356406235
Name:DEBRA K CARTER PH D & ASSOCIATES PA
Entity type:Organization
Organization Name:DEBRA K CARTER PH D & ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:941-753-0064
Mailing Address - Street 1:4835 27TH ST W
Mailing Address - Street 2:SUITE 125
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-1768
Mailing Address - Country:US
Mailing Address - Phone:941-753-0064
Mailing Address - Fax:941-753-2977
Practice Address - Street 1:4835 27TH ST W
Practice Address - Street 2:SUITE 125
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1768
Practice Address - Country:US
Practice Address - Phone:941-753-0064
Practice Address - Fax:941-753-2977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1171Medicare ID - Type Unspecified