MEDICARE: DESIREE CARTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	34012736A	IN

General Provider Information

NPI Number	:	1124973789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESIREE CARTER

Provider Business Mailing Address
First Line	:	415 MERCEDES LN APT D
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-4598
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 EXECUTIVE DR STE E
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-4875
Country	:	US
Telephone Number	:	317-628-9724
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2026
Last Update Date	:	06/23/2026

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Directions to “ DESIREE CARTER ” Practice Location

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