Provider Demographics
NPI:1043860588
Name:CARTER, MATTHEW R (MSW, CSW INTERN)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:R
Last Name:CARTER
Suffix:
Gender:M
Credentials:MSW, CSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:NV
Mailing Address - Zip Code:89301-3500
Mailing Address - Country:US
Mailing Address - Phone:775-296-2441
Mailing Address - Fax:775-289-1699
Practice Address - Street 1:1675 AVENUE F
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:NV
Practice Address - Zip Code:89301-3500
Practice Address - Country:US
Practice Address - Phone:775-296-2441
Practice Address - Fax:775-289-1699
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVIC-1456OtherCLINICAL SOCIAL WORKER INTERN