Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY10741 | FL |
Y | 103TC0700X | Clinical Psychologist | PY10741 | FL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 295 | ND |
NPI | 1093757791 |
---|---|
Provider Name | Carita R Shawchuck |
First Address | Largo, FL 33774-4114 |
Second Address | Largo, FL 33774-4114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 28/08/2021 |