Basic Information
| Provider Information | |||||||||
| NPI: | 1528051448 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARPENTER | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2011 ASHWOOD AVE | ||||||||
| Address2: | SUITE 331 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153834694 | ||||||||
| FaxNumber: | 6153830228 | ||||||||
| Practice Location | |||||||||
| Address1: | 2011 ASHWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158894447 | ||||||||
| FaxNumber: | 6158895891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2005 | ||||||||
| LastUpdateDate: | 06/19/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/27/2006 | ||||||||
| NPIReactivationDate: | 04/03/2006 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | P1477 | TN | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 091862000 | 01 | TN | MAGELLAN | OTHER | 3687099 | 05 | TN | MEDICAID | 175814 | 01 | TN | COMPSYCH | OTHER | 3159358 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | 620006821 | 01 | TN | TRICARE/CHAMPUS | OTHER | 4346718 | 01 | TN | AETNA | OTHER | 016715 | 01 | TN | VALUE OPTIONS | OTHER |