Provider Demographics
NPI:1194734178
Name:CARTER, PATRICIA T (LICSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:T
Last Name:CARTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 WATER ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01267-2888
Mailing Address - Country:US
Mailing Address - Phone:413-458-8582
Mailing Address - Fax:413-458-8750
Practice Address - Street 1:173 WATER ST STE 1
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:MA
Practice Address - Zip Code:01267
Practice Address - Country:US
Practice Address - Phone:413-458-8582
Practice Address - Fax:413-458-8750
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1169781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT010252719Medicaid
009950F10Medicare ID - Type Unspecified
VT010252719Medicaid