Healthcare Provider Details

I. General information

NPI: 1689451718
Provider Name (Legal Business Name): NAILAH CARPENTER BSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 E WOODRUFF AVE
TOLEDO OH
43604-5367
US

IV. Provider business mailing address

1425 STARR AVE
TOLEDO OH
43605-2456
US

V. Phone/Fax

Practice location:
  • Phone: 419-242-9577
  • Fax: 419-936-7606
Mailing address:
  • Phone: 419-936-7600
  • Fax: 419-936-7606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2410575
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: