=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942577705
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARRIE CHAMP MORERA PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2011
-----------------------------------------------------
Last Update Date | 04/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 128 S THISTLEDOWN DR
-----------------------------------------------------
City | PALMYRA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17078-9023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-903-7526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7901 4TH STREET N STE 300
-----------------------------------------------------
City | ST. PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-903-7526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | PC004246
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PS016768
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------