Provider Demographics
NPI:1457575904
Name:PRATT, CARLOS WILSON (PHD)
Entity type:Individual
Prefix:PROF
First Name:CARLOS
Middle Name:WILSON
Last Name:PRATT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3420
Mailing Address - Country:US
Mailing Address - Phone:908-889-2461
Mailing Address - Fax:908-889-2432
Practice Address - Street 1:1776 RARITAN RD
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-2928
Practice Address - Country:US
Practice Address - Phone:908-889-2461
Practice Address - Fax:908-889-2432
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist