Provider Demographics
NPI:1871508317
Name:CARPENTER, GEORGE R (LCSW)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:R
Last Name:CARPENTER
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 1:2 SPRINGBROOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3253
Mailing Address - Country:US
Mailing Address - Phone:207-282-1500
Mailing Address - Fax:207-282-7509
Practice Address - Street 1:407 ALFRED ST
Practice Address - Street 2:PARK ONE ELEVEN
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3760
Practice Address - Country:US
Practice Address - Phone:207-284-5554
Practice Address - Fax:207-284-5551
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC58931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME1355Medicare ID - Type Unspecified