Provider Demographics
NPI:1437821899
Name:CARTY, CHAUNTELLE CLAUDINE
Entity type:Individual
Prefix:
First Name:CHAUNTELLE
Middle Name:CLAUDINE
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 1:55 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANTRIM
Mailing Address - State:NH
Mailing Address - Zip Code:03440-3906
Mailing Address - Country:US
Mailing Address - Phone:603-808-0185
Mailing Address - Fax:603-808-0211
Practice Address - Street 1:55 MAIN ST
Practice Address - Street 2:
Practice Address - City:ANTRIM
Practice Address - State:NH
Practice Address - Zip Code:03440-3906
Practice Address - Country:US
Practice Address - Phone:603-808-0185
Practice Address - Fax:603-808-0211
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04927923363LP0808X
MA244446363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health