Provider Demographics
NPI:1962550483
Name:CARPENTER, GAIL A (LICSW)
Entity type:Individual
Prefix:MISS
First Name:GAIL
Middle Name:A
Last Name:CARPENTER
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 1:219 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5407
Mailing Address - Country:US
Mailing Address - Phone:401-207-1073
Mailing Address - Fax:
Practice Address - Street 1:243 GORHAM ST APT 1107
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1869
Practice Address - Country:US
Practice Address - Phone:401-207-1073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW017001041C0700X
NYR049576-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI29078-0OtherBLUECROSS-BLUESHIELD
RI345114OtherTRICARE-MHN
RIGC58613Medicaid
RI1062670OtherNHP
RI412060OtherBLUE CHIP
RI6278124OtherUBH
RI345114OtherTRICARE-MHN