Provider Demographics
NPI:1730314493
Name:CARLSON, JENNIFER ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANN
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E 68TH ST
Mailing Address - Street 2:APT 12K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-5718
Mailing Address - Country:US
Mailing Address - Phone:917-769-9609
Mailing Address - Fax:212-792-6058
Practice Address - Street 1:215 E 68TH ST
Practice Address - Street 2:APT 12K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-5718
Practice Address - Country:US
Practice Address - Phone:917-769-9609
Practice Address - Fax:212-792-6058
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0801791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical