Provider Demographics
NPI:1790923035
Name:CARTER-BARTH, DEBRA LYNN (LICSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:CARTER-BARTH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 1ST AVE NE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5268
Mailing Address - Country:US
Mailing Address - Phone:507-412-1468
Mailing Address - Fax:507-331-8677
Practice Address - Street 1:303 1ST AVE NE
Practice Address - Street 2:SUITE 240
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5268
Practice Address - Country:US
Practice Address - Phone:507-412-1468
Practice Address - Fax:507-331-8677
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-24
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17263101YM0800X, 103TP2701X, 1041C0700X, 106H00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1790923035Medicaid