Healthcare Provider Details

I. General information

NPI: 1356595722
Provider Name (Legal Business Name): KAROLYN ANN CARPENTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 B HIGHWAY 72 E
ROLLA MO
65402
US

IV. Provider business mailing address

PO BOX 7
ROLLA MO
65402-0007
US

V. Phone/Fax

Practice location:
  • Phone: 573-426-5181
  • Fax: 573-426-4817
Mailing address:
  • Phone: 573-426-5181
  • Fax: 573-426-4817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2008020672
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: