Provider Demographics
NPI:1972773083
Name:CARPENTER, KEA M (LCSW, BCD)
Entity Type:Individual
Prefix:
First Name:KEA
Middle Name:M
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 E 20TH ST
Mailing Address - Street 2:#2H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-8238
Mailing Address - Country:US
Mailing Address - Phone:646-283-7403
Mailing Address - Fax:
Practice Address - Street 1:80 5TH AVE
Practice Address - Street 2:STE. 903A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8002
Practice Address - Country:US
Practice Address - Phone:646-283-7403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078158-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical