Provider Demographics
NPI:1740482272
Name:CARTER, FANYA (PHD)
Entity type:Individual
Prefix:MRS
First Name:FANYA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 OCEAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-2630
Mailing Address - Country:US
Mailing Address - Phone:310-395-0523
Mailing Address - Fax:310-395-3609
Practice Address - Street 1:515 OCEAN AVENUE
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90402-2630
Practice Address - Country:US
Practice Address - Phone:310-395-0523
Practice Address - Fax:310-395-3609
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8168103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY8168OtherPSYCHOLOGIST LICENSE