Provider Demographics
NPI:1235343799
Name:CARPENTER, WAYNE D (PHD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:D
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HERRICK PL
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1540
Mailing Address - Country:US
Mailing Address - Phone:413-530-9215
Mailing Address - Fax:
Practice Address - Street 1:1215 WILBRAHAM RD
Practice Address - Street 2:COUNSELING SERVICES
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01119-2654
Practice Address - Country:US
Practice Address - Phone:413-530-9215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1839101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health