Provider Demographics
NPI:1316004922
Name:CARLSON, MARY JO (LCSW)
Entity type:Individual
Prefix:
First Name:MARY JO
Middle Name:
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:PO BOX 894
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-0894
Mailing Address - Country:US
Mailing Address - Phone:412-925-3352
Mailing Address - Fax:412-833-1578
Practice Address - Street 1:2770 S PARK RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-3839
Practice Address - Country:US
Practice Address - Phone:412-925-3352
Practice Address - Fax:412-925-3352
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0169901041C0700X
MO0044591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical