Provider Demographics
NPI:1144678590
Name:CARPENTER, JOANNA MARIE (BSW)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:MARIE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:MARIE
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 KY 225
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906
Mailing Address - Country:US
Mailing Address - Phone:859-209-2340
Mailing Address - Fax:606-545-9555
Practice Address - Street 1:415 KY 225
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906
Practice Address - Country:US
Practice Address - Phone:859-209-2340
Practice Address - Fax:606-545-9555
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical