Provider Demographics
NPI:1417214032
Name:CARVER, JACQUELINE C (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:C
Last Name:CARVER
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 STATE ROUTE 61
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:OH
Mailing Address - Zip Code:44827-9451
Mailing Address - Country:US
Mailing Address - Phone:419-617-9173
Mailing Address - Fax:
Practice Address - Street 1:2423 ALLENTOWN RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-1711
Practice Address - Country:US
Practice Address - Phone:419-222-7723
Practice Address - Fax:419-222-6212
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.12012431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical