Provider Demographics
NPI:1306970223
Name:CARPENTER-BIXLER, CONSTANCE JEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:JEAN
Last Name:CARPENTER-BIXLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CONSTANCE
Other - Middle Name:J
Other - Last Name:CARPENTER-BIXLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 861
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-0861
Mailing Address - Country:US
Mailing Address - Phone:413-297-3097
Mailing Address - Fax:
Practice Address - Street 1:130 MAPLE ST
Practice Address - Street 2:SUITE 326
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2202
Practice Address - Country:US
Practice Address - Phone:413-297-3097
Practice Address - Fax:413-854-6061
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7168103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110083668AMedicaid
MAW51213Medicare UPIN