Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | I.0800316 | OH |
N | 1041C0700X | Clinical Social Worker | I.0800316 | OH |
NPI | 1003066242 |
---|---|
Provider Name | Mr. Roben Lee Carter SR. |
First Address | East Liverpool, OH 43920-8941 |
Second Address | East Liverpool, OH 43920-2129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2008 |
Last Update Date | 24/09/2008 |