Provider Demographics
NPI:1386963502
Name:CARPENTER, LAURA MAE (MSSW, CSW)
Entity type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:MAE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:MSSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9809 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8301 HARCOURT RD STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2082
Practice Address - Country:US
Practice Address - Phone:317-415-6600
Practice Address - Fax:317-415-6649
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3364104100000X
KY2532311041C0700X
IN34008947A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker