Provider Demographics
NPI:1104097914
Name:CARRETTA, CARRIE M (PHD, APN-C)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:M
Last Name:CARRETTA
Suffix:
Gender:F
Credentials:PHD, APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 SITLINGTON LN
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6220
Mailing Address - Country:US
Mailing Address - Phone:732-535-0414
Mailing Address - Fax:848-863-6574
Practice Address - Street 1:414 SITLINGTON LN
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78738-6220
Practice Address - Country:US
Practice Address - Phone:732-535-0414
Practice Address - Fax:848-863-6574
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18396363LP0808X
NJ26NJ00156100363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health