Provider Demographics
NPI:1932603198
Name:CARTY, WINSTON A JR
Entity Type:Individual
Prefix:MR
First Name:WINSTON
Middle Name:A
Last Name:CARTY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20210 NE 2ND AVE APT V33
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-2390
Mailing Address - Country:US
Mailing Address - Phone:786-471-6295
Mailing Address - Fax:
Practice Address - Street 1:20210 NE 2ND AVE APT V33
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-2390
Practice Address - Country:US
Practice Address - Phone:786-471-6295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLATN702621Medicaid