Provider Demographics
NPI:1669215034
Name:CARTER, JESSE L (MA)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:L
Last Name:CARTER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 STOCKBRIDGE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-9512
Mailing Address - Country:US
Mailing Address - Phone:413-644-0171
Mailing Address - Fax:
Practice Address - Street 1:420 STOCKBRIDGE RD STE 5
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-9512
Practice Address - Country:US
Practice Address - Phone:413-644-0171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health