Provider Demographics
NPI:1992750251
Name:CARPENTER, PATRICIA ANNE (LICMSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANNE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LICMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 SAND RD.
Mailing Address - Street 2:
Mailing Address - City:FERRISBURG
Mailing Address - State:VT
Mailing Address - Zip Code:05456
Mailing Address - Country:US
Mailing Address - Phone:802-388-3983
Mailing Address - Fax:
Practice Address - Street 1:112 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1104
Practice Address - Country:US
Practice Address - Phone:802-388-3983
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900010311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical