Provider Demographics
NPI:1972871671
Name:CARLSON, DEBRA
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 64TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3455
Mailing Address - Country:US
Mailing Address - Phone:718-787-1100
Mailing Address - Fax:718-787-9598
Practice Address - Street 1:425 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1629
Practice Address - Country:US
Practice Address - Phone:718-787-1100
Practice Address - Fax:718-787-9598
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor