Provider Demographics
NPI:1831835420
Name:CARTY, MARCIA
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:CARTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 NW 1ST AVE STE 3A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-3536
Mailing Address - Country:US
Mailing Address - Phone:786-291-3939
Mailing Address - Fax:
Practice Address - Street 1:915 NW 1ST AVE STE 3A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-3536
Practice Address - Country:US
Practice Address - Phone:786-291-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-07
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL134346087Medicaid