Provider Demographics
NPI:1740943406
Name:CARPENTER, SHELBY (RBT)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33312 LAKE BEND CIR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3689
Mailing Address - Country:US
Mailing Address - Phone:407-752-8655
Mailing Address - Fax:
Practice Address - Street 1:1650 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-2841
Practice Address - Country:US
Practice Address - Phone:352-314-3760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2025-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB387858106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician