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General NPI Number Information
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NPI Number | 1346370020
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Entity Type | Individual
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Provider Name | DAVID JASON CARPENTER LMSW
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Gender | Male
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2345 WEST 12 MILE ROAD
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City | BERKLEY
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State | MI
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Zip | 48072
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Country | US
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Telephone | 248-544-7006
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Fax |
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Provider Business Mailing Address
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Address Line | 114 ORCHARD LAKE RD
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City | PONTIAC
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State | MI
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Zip | 48341-2244
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Country | US
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Telephone | 248-858-7766
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Fax | 248-858-7201
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801078829
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License Number State | MI
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