Provider Demographics
NPI:1609949346
Name:CARTER, GERTRUDE C (LICSW(MASS) CSW RN)
Entity type:Individual
Prefix:MS
First Name:GERTRUDE
Middle Name:C
Last Name:CARTER
Suffix:
Gender:F
Credentials:LICSW(MASS) CSW RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 615
Mailing Address - Street 2:41 WINTER STREET
Mailing Address - City:EDGARTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02539-0615
Mailing Address - Country:US
Mailing Address - Phone:508-627-8803
Mailing Address - Fax:
Practice Address - Street 1:41 WINTER STREET
Practice Address - Street 2:BOX 615
Practice Address - City:EDGARTOWN
Practice Address - State:MA
Practice Address - Zip Code:02539-0615
Practice Address - Country:US
Practice Address - Phone:508-627-8803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1016681041C0700X
VT08900002462461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical