Provider Demographics
NPI:1083349880
Name:CARPENTER, JACOB JAMES (MSW)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:JAMES
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 CHARTER RD
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4307
Mailing Address - Country:US
Mailing Address - Phone:802-380-9473
Mailing Address - Fax:
Practice Address - Street 1:77 CHARTER RD
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4307
Practice Address - Country:US
Practice Address - Phone:802-380-9473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT144991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical