Provider Demographics
NPI:1548093412
Name:CARLSON, ROBERT RYAN (LPC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RYAN
Last Name:CARLSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:46 SUSAN DR
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-2537
Mailing Address - Country:US
Mailing Address - Phone:860-836-1497
Mailing Address - Fax:
Practice Address - Street 1:392 MERROW RD
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3974
Practice Address - Country:US
Practice Address - Phone:860-830-7838
Practice Address - Fax:860-454-0667
Is Sole Proprietor?:No
Enumeration Date:2024-08-24
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007534101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional