Provider Demographics
NPI:1518288448
Name:CARPENTER, TERI L (LISW-S)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:L
Last Name:CARPENTER
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 1:1029 W HIGH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-2071
Mailing Address - Country:US
Mailing Address - Phone:330-364-9360
Mailing Address - Fax:330-364-9769
Practice Address - Street 1:1029 W HIGH AVE
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-2071
Practice Address - Country:US
Practice Address - Phone:330-364-9360
Practice Address - Fax:330-364-9769
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00088121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical