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Provider Information for 1902883283


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MARTHA SUSAN CARTER LICSW


Sex: Female

NPI: 1902883283
Last Updated: 2018-01-04
Certification Date:

Details

NameValue
NPI1902883283
Enumeration Date2005-12-28
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 2550 UNIVERSITY AVENUE WEST
SUITE 229N
ST PAUL, MN 55114
United States

Phone: 651-645-3115 | Fax:654-645-2752
 
Primary Practice Address 2925 CHICAGO AVE
MINNEAPOLIS, MN 55407-1321
United States

Phone: 612-863-8511 | Fax:612-863-8516
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDMN176648100
Other (non-Medicare)200RICABCBS of MN
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 104100000X - Social Worker MN15337
Yes 1041C0700X - Social Worker - ClinicalMN15337