Healthcare Provider Details

I. General information

NPI: 1396467296
Provider Name (Legal Business Name): STEVEN K CARTER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 BROADWAY
NEW YORK NY
10027-7164
US

IV. Provider business mailing address

120 YORK ST APT 504
JERSEY CITY NJ
07302-3752
US

V. Phone/Fax

Practice location:
  • Phone: 212-854-2878
  • Fax:
Mailing address:
  • Phone: 646-595-5995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number025187
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: