Provider Demographics
NPI:1053626085
Name:CARPENTER, JAMES ANDREW (LMSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ANDREW
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 E MAGIC VIEW DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3154
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2950 E MAGIC VIEW DR
Practice Address - Street 2:SUITE 140
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-3154
Practice Address - Country:US
Practice Address - Phone:208-794-6455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-14
Last Update Date:2010-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker