Provider Demographics
NPI:1831240258
Name:CARTER, GERALD L (LISW)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:L
Last Name:CARTER
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 HUNT RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6612
Mailing Address - Country:US
Mailing Address - Phone:513-891-0650
Mailing Address - Fax:513-891-2838
Practice Address - Street 1:8806 CINCINNATI DAYTON RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3135
Practice Address - Country:US
Practice Address - Phone:513-755-1777
Practice Address - Fax:513-759-9977
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-0004132104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000262214OtherANTHEM PROVIDER NUMBER
OHSW20016Medicare ID - Type Unspecified