Provider Demographics
NPI:1124730825
Name:CARLSSON, STEVEN (PSYD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:CARLSSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 SUN ISLE CIR UNIT 308
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-2728
Mailing Address - Country:US
Mailing Address - Phone:407-687-0678
Mailing Address - Fax:
Practice Address - Street 1:231 SUN ISLE CIR UNIT 308
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-2728
Practice Address - Country:US
Practice Address - Phone:407-687-0678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11684103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical