Provider Demographics
NPI:1366501165
Name:CARPENTER, KATHLEEN (PSYD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 DRESDEN DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-8803
Mailing Address - Country:US
Mailing Address - Phone:916-543-5437
Mailing Address - Fax:
Practice Address - Street 1:1900 DRESDEN DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-8803
Practice Address - Country:US
Practice Address - Phone:916-543-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17473103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service