Provider Demographics
NPI:1588087365
Name:CARLSON, JENNIFER A (CASAC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:CARLSON
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:37 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2930
Mailing Address - Country:US
Mailing Address - Phone:631-424-2900
Mailing Address - Fax:631-608-1057
Practice Address - Street 1:37 JOHN ST
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2930
Practice Address - Country:US
Practice Address - Phone:631-424-2900
Practice Address - Fax:631-608-1057
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)