Provider Demographics
NPI:1720502081
Name:CARTER, PATRICK (BEHAVIOR HEALTH TECH)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:CARTER
Suffix:
Gender:M
Credentials:BEHAVIOR HEALTH TECH
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 923
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32145-0923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6195 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:FL
Practice Address - Zip Code:32145-5592
Practice Address - Country:US
Practice Address - Phone:904-208-1503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1386021897Medicaid
FL1356702542Medicaid