Provider Demographics
NPI:1265645584
Name:CARPER, BRENDA SUE (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUE
Last Name:CARPER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 6TH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-1265
Mailing Address - Country:US
Mailing Address - Phone:304-768-6170
Mailing Address - Fax:304-768-2099
Practice Address - Street 1:312 6TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1265
Practice Address - Country:US
Practice Address - Phone:304-768-6170
Practice Address - Fax:304-768-2099
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP008171601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9262581OtherMEDICARE GROUP
WVSW09622Medicare PIN
WV0008398000OtherMEDICAID GROUP