Provider Demographics
NPI:1851723654
Name:CARTER, JARED C (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:C
Last Name:CARTER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3888 E BANCROFT CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-8294
Mailing Address - Country:US
Mailing Address - Phone:480-255-0860
Mailing Address - Fax:
Practice Address - Street 1:2 WATER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-2126
Practice Address - Country:US
Practice Address - Phone:207-532-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC14206104100000X
AZLCSW-173931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
13774003OtherCAQH PROVIEW
AZLCSW-17393OtherAZ BOARD OF BEHAVIORAL HEALTH EXAMINERS