Active NPI
Carly Bobal, PSYD
- Psychologist
- Charlotte, NC
National Provider Identifier
1205509841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 103409
- Practice address
- 5960 Fairview Rd Ste 302
Charlotte, NC 28210-3102 - Phone
- (704) 966-9010
- NPI assigned
- Jul 29, 2021
- Last updated
- Jul 29, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 103409 | NC | Primary |
| Cognitive & Behavioral Psychologist | 103TB0200X | 103409 | NC | |
| Clinical Psychologist | 103TC0700X | 103409 | NC | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 103409 | NC | |
| Family Psychologist | 103TF0000X | 103409 | NC | |
| Health Service Psychologist | 103TH0100X | 103409 | NC | |
| School Psychologist | 103TS0200X | 103409 | NC |
Addresses
Primary practice location
5960 Fairview Rd Ste 302
Charlotte, NC 28210-3102
Mailing address
114 Breton CT
Mooresville, NC 28117-5962
Phone (518) 527-0134
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103409 | NC | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627516800000",
"number": "1205509841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "114 BRETON CT",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "281175962",
"telephone_number": "518-527-0134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5960 FAIRVIEW RD STE 302",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282103102",
"telephone_number": "704-966-9010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOBAL",
"first_name": "CARLY",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-07-29",
"last_updated": "2021-07-29",
"certification_date": "2021-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "103409",
"primary": true
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "NC",
"license": "103409",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "103409",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "NC",
"license": "103409",
"primary": false
},
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": "NC",
"license": "103409",
"primary": false
},
{
"code": "103TH0100X",
"taxonomy_group": "",
"desc": "Psychologist, Health Service",
"state": "NC",
"license": "103409",
"primary": false
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "NC",
"license": "103409",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.