Provider Demographics
NPI:1487144739
Name:CARLTON, SALLY B (PHD)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:B
Last Name:CARLTON
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 1:84 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-1852
Mailing Address - Country:US
Mailing Address - Phone:413-478-9838
Mailing Address - Fax:
Practice Address - Street 1:84 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-1852
Practice Address - Country:US
Practice Address - Phone:413-478-9838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-12
Last Update Date:2018-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6723-PY-PR103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6723-PY-PROtherDIV. OF PROF.LICENSURE