Provider Demographics
NPI:1780865337
Name:CARPENTER, JAMES TYLER (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TYLER
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366063
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-0019
Mailing Address - Country:US
Mailing Address - Phone:617-698-8350
Mailing Address - Fax:
Practice Address - Street 1:NEUROBEHAVIORAL ASSOCIATES
Practice Address - Street 2:169 LIBBEY PARKWAY, 2ND FLOOR
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189
Practice Address - Country:US
Practice Address - Phone:781-682-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4303103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0518018Medicaid