Provider Demographics
NPI:1568032217
Name:CARPENTER, AMBRIA (MS)
Entity Type:Individual
Prefix:
First Name:AMBRIA
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 ROOSEVELT AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-2134
Mailing Address - Country:US
Mailing Address - Phone:317-435-3413
Mailing Address - Fax:401-724-8488
Practice Address - Street 1:249 ROOSEVELT AVE STE 205
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-2134
Practice Address - Country:US
Practice Address - Phone:401-729-8701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator