MEDICARE: DR. JENNIFER CARLSON PSY. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	4758	NJ

General Provider Information

NPI Number	:	1427418524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER CARLSON PSY. D.

Provider Business Mailing Address
First Line	:	10 MCKINLEY ST STE 12
Second Line	:
City	:	CLOSTER
State	:	NJ
Zip	:	07624-2726
Country	:	US
Telephone Number	:	201-960-6614
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 MCKINLEY ST STE 12
Second Line	:
City	:	CLOSTER
State	:	NJ
Zip	:	07624-2726
Country	:	US
Telephone Number	:	201-960-6614
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2016
Last Update Date	:	05/04/2022

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