Provider Demographics
NPI:1699824383
Name:CARPENTER, LARA
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3270 SUNTREE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3270 SUNTREE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7530
Practice Address - Country:US
Practice Address - Phone:321-752-3170
Practice Address - Fax:321-752-3179
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker