Provider Demographics
NPI:1154162618
Name:CARPENTER, MARY ANN (LMFT)
Entity type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 WINDING WOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3260
Mailing Address - Country:US
Mailing Address - Phone:707-477-3344
Mailing Address - Fax:
Practice Address - Street 1:453 WINDING WOOD WAY
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3260
Practice Address - Country:US
Practice Address - Phone:707-477-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT18772106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist