Provider Demographics
NPI:1932945144
Name:CARLSON, MARIEL LOUISE (MSW, LGSW, LMSW)
Entity type:Individual
Prefix:
First Name:MARIEL
Middle Name:LOUISE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MSW, LGSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 HARMON PL STE 103
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2045
Mailing Address - Country:US
Mailing Address - Phone:612-363-1097
Mailing Address - Fax:
Practice Address - Street 1:1201 HARMON PL STE 103
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2045
Practice Address - Country:US
Practice Address - Phone:612-363-1097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2025-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31254104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker