Healthcare Provider Details

I. General information

NPI: 1205578804
Provider Name (Legal Business Name): OLIVIA CARTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CC4 CALLE BOHIQUE
CAGUAS PR
00725-1459
US

IV. Provider business mailing address

CC4 CALLE BOHIQUE
CAGUAS PR
00725-1459
US

V. Phone/Fax

Practice location:
  • Phone: 203-213-0872
  • Fax:
Mailing address:
  • Phone: 203-313-5537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-58664
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: