Provider Demographics
NPI:1952351454
Name:CARVER, CAROL A (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:A
Last Name:CARVER
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 1:2380 NW KINGS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3978
Mailing Address - Country:US
Mailing Address - Phone:541-757-2066
Mailing Address - Fax:541-757-9651
Practice Address - Street 1:2380 NW KINGS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3978
Practice Address - Country:US
Practice Address - Phone:541-757-2066
Practice Address - Fax:541-757-9651
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR477103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR127329Medicaid
OR0000TCHPQMedicare ID - Type UnspecifiedPSYCHOLOGIST
ORROOOOTCHPQMedicare PIN
ORR13529Medicare UPIN