Provider Demographics
NPI:1104967231
Name:DUCAT, CAROL JEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:JEAN
Last Name:DUCAT
Suffix:
Gender:
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:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2193 ASSOCIATION DR STE 100
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-4904
Practice Address - Country:US
Practice Address - Phone:517-349-6608
Practice Address - Fax:517-349-3755
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002545103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OC34605Medicare ID - Type Unspecified