Jacob James Carpenter, MSW
Individual provider Active NPI Clinical Social Worker · Wethersfield, CT
NPI 1083349880 · NPPES record last updated Oct 2, 2024
Key facts
- NPI
- 1083349880
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 14499 (CT)
- Practice address
- 77 Charter Rd
Wethersfield, CT 06109-4307 - Phone
- (802) 380-9473
- NPI assigned
- Jul 18, 2022
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14499 | CT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cornerstones of Maine Inc. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 14499 | CT | Yes |
Addresses
Primary practice location
77 Charter Rd
Wethersfield, CT 06109-4307
Mailing address
77 Charter Rd
Wethersfield, CT 06109-4307
Phone (802) 380-9473
Other providers in Wethersfield, CT
- Care of Hope
- Brittany M Carilli
- Karen L Carney
- Caro Counseling & Psychotherapy Group
- Adriana Caro
- Elaine Carroll
- Brooke Carson
- Julie Casertano
- Victoria A Cassano
- Center for Multicultural Psychological Services
All providers in Wethersfield, CT · Clinical Social Worker in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 2, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.