Provider Demographics
NPI:1528051448
Name:CARPENTER, SUSAN B (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:B
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 ASHWOOD AVE
Mailing Address - Street 2:SUITE 331
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212
Mailing Address - Country:US
Mailing Address - Phone:615-383-4694
Mailing Address - Fax:615-383-0228
Practice Address - Street 1:2011 ASHWOOD AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212
Practice Address - Country:US
Practice Address - Phone:615-889-4447
Practice Address - Fax:615-889-5891
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2018-06-19
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
TNP1477103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN091862000OtherMAGELLAN
TN3687099Medicaid
TN175814OtherCOMPSYCH
TN3159358OtherBLUE CROSS BLUE SHIELD
TN620006821OtherTRICARE/CHAMPUS
TN4346718OtherAETNA
TN016715OtherVALUE OPTIONS
TN4346718OtherAETNA