Healthcare Provider Details

I. General information

NPI: 1457434870
Provider Name (Legal Business Name): CLETUS SAVIO CARVALHO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3070 LAKECREST CIR # 400-197
LEXINGTON KY
40513-1937
US

IV. Provider business mailing address

3070 LAKECREST CIR # 400-197
LEXINGTON KY
40513-1937
US

V. Phone/Fax

Practice location:
  • Phone: 859-263-3888
  • Fax: 888-235-9895
Mailing address:
  • Phone: 859-263-3888
  • Fax: 888-235-9895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35167
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number35167
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: