MEDICARE: KANDICE DEVON ANN CARTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1235856956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANDICE DEVON ANN CARTER

Provider Business Mailing Address
First Line	:	111 S CATHERINE ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21223-2027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 S CATHERINE ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21223-2027
Country	:	US
Telephone Number	:	443-240-6521
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	10/25/2022

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Directions to “ KANDICE DEVON ANN CARTER ” Practice Location

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