Provider Demographics
NPI:1942584867
Name:CARPENTER, KATHLEEN (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3671 SOUTHWESTERN BLVD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1752
Mailing Address - Country:US
Mailing Address - Phone:716-662-7008
Mailing Address - Fax:716-662-5226
Practice Address - Street 1:3671 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE 213
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1752
Practice Address - Country:US
Practice Address - Phone:716-662-7008
Practice Address - Fax:716-662-5226
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0380981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical