Provider Demographics
NPI:1003066242
Name:CARTER, ROBEN LEE SR (LISW)
Entity Type:Individual
Prefix:MR
First Name:ROBEN
Middle Name:LEE
Last Name:CARTER
Suffix:SR
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13529 OLD FREDERICKTOWN RD
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-8941
Mailing Address - Country:US
Mailing Address - Phone:330-385-6337
Mailing Address - Fax:
Practice Address - Street 1:1302 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-2129
Practice Address - Country:US
Practice Address - Phone:330-386-6674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0800316104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical