Provider Demographics
NPI:1457893356
Name:MCPHETERS, CAROL (PHD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:MCPHETERS
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 CAMINO DEL MAR # 416
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2605
Mailing Address - Country:US
Mailing Address - Phone:858-345-2025
Mailing Address - Fax:
Practice Address - Street 1:9340 CARMEL MOUNTAIN RD STE E
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129
Practice Address - Country:US
Practice Address - Phone:858-345-2025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst