MEDICARE: GLEN ALAN CARPENTER

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	I.1302311	OH

General Provider Information

NPI Number	:	1376941120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLEN ALAN CARPENTER

Provider Business Mailing Address
First Line	:	2217 WARREN ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43620-1352
Country	:	US
Telephone Number	:	419-699-3357
Fax Number	:	419-491-4886

Provider Business Practice Location Address
First Line	:	1544 S BYRNE RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-3465
Country	:	US
Telephone Number	:	419-509-3442
Fax Number	:	419-491-4886

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

Provider Enumeration Date	:	12/10/2014
Last Update Date	:	03/24/2023

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Directions to “ GLEN ALAN CARPENTER ” Practice Location

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