Provider Demographics
NPI:1235311366
Name:CARPENTER, ANGEL (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 E 100 N
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-3413
Mailing Address - Country:US
Mailing Address - Phone:765-450-5657
Mailing Address - Fax:765-450-6353
Practice Address - Street 1:1539 E 100 N
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-3413
Practice Address - Country:US
Practice Address - Phone:765-450-5657
Practice Address - Fax:765-450-6353
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006708A1041C0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty