1962550483 NPI number — MISS GAIL A CARPENTER LICSW

Table of content: MISS GAIL A CARPENTER LICSW (NPI 1962550483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962550483 NPI number — MISS GAIL A CARPENTER LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARPENTER
Provider First Name:
GAIL
Provider Middle Name:
A
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962550483
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
219 BOULEVARD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02842-5407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-207-1073
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
243 GORHAM ST APT 1107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANANDAIGUA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14424-1869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-207-1073
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  ISW01700 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: R049576-01 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 29078-0 . This is a "BLUECROSS-BLUESHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 345114 . This is a "TRICARE-MHN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: GC58613 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1062670 . This is a "NHP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 412060 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 6278124 . This is a "UBH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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