Provider Demographics
NPI:1992731723
Name:CARTER, STUART (PHD)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:CARTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-3129
Mailing Address - Country:US
Mailing Address - Phone:978-549-3570
Mailing Address - Fax:
Practice Address - Street 1:49 ROBINWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-2156
Practice Address - Country:US
Practice Address - Phone:617-390-1427
Practice Address - Fax:617-390-1576
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2199103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0508764Medicaid
MAW02798OtherBLUE CROSS BLUE SHIELD
MAW02798OtherBLUE CROSS BLUE SHIELD