Provider Demographics
NPI:1003343625
Name:CARTER, MAUREEN ISABELLA (ASW)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ISABELLA
Last Name:CARTER
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 HUDIS ST
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-1446
Mailing Address - Country:US
Mailing Address - Phone:707-481-2953
Mailing Address - Fax:
Practice Address - Street 1:850 HUDIS ST
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-1446
Practice Address - Country:US
Practice Address - Phone:707-481-2953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker