Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PY3897 | FL |
N | 103TC0700X | Clinical Psychologist | PY3897 | FL |
N | 103TF0000X | Family Psychologist | PY3897 | FL |
Y | 103TF0200X | Forensic Psychologist | PY3897 | FL |
N | 103TH0100X | Health Service | PY3897 | FL |
NPI | 1073672333 |
---|---|
Provider Name | Debra K Carter |
First Address | Bradenton, FL 34207 |
Second Address | Bradenton, FL 34207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 23/01/2019 |