Healthcare Provider Details

I. General information

NPI: 1942302401
Provider Name (Legal Business Name): STEPHANIE REDER CARTER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7325 SW 63RD AVE SUITE 101
SOUTH MIAMI FL
33143-4811
US

IV. Provider business mailing address

3400 SW 27TH AVE APT. 1902
MIAMI FL
33133-5307
US

V. Phone/Fax

Practice location:
  • Phone: 305-284-1143
  • Fax: 305-667-9880
Mailing address:
  • Phone: 305-284-1143
  • Fax: 305-667-9880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: