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General NPI Number Information
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NPI Number | 1770801185
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Entity Type | Individual
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Provider Name | GREGORY DALE CARPENTER M.DIV
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Gender | Male
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Dates
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Enumeration Date | 05/10/2010
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Last Update Date | 05/10/2010
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Provider Practice Location Address
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Address Line | 546 ARCADE AVE STE 6
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City | SEEKONK
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State | MA
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Zip | 02771-5130
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Country | US
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Telephone | 401-265-2951
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Fax | 508-557-1387
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Provider Business Mailing Address
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Address Line | 546 ARCADE AVE STE 6
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City | SEEKONK
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State | MA
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Zip | 02771-5130
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Country | US
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Telephone | 401-265-2951
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Fax | 508-557-1387
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 247
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License Number State | MA
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