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General NPI Number Information
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NPI Number | 1902883283
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Entity Type | Individual
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Provider Name | MARTHA SUSAN CARTER LICSW
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Gender | Female
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 01/04/2018
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Provider Practice Location Address
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Address Line | 2925 CHICAGO AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-1321
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Country | US
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Telephone | 612-863-8511
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Fax | 612-863-8516
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Provider Business Mailing Address
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Address Line | 2550 UNIVERSITY AVENUE WEST SUITE 229N
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City | ST PAUL
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State | MN
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Zip | 55114
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Country | US
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Telephone | 651-645-3115
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Fax | 654-645-2752
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 15337
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 15337
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License Number State | MN
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