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NPI Code Detail

MEDICARE: DIANE L CARLSON LICSW

MEDICARE: DIANE L CARLSON LICSW
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
11041C0700XClinical Social Worker100478MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1761754OTHERMATUFTS HEALTH PLAN
2PO1190OTHERMAMASS BC BS ID

General Provider Information

NPI Number : 1538104575
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE L CARLSON LICSW
Provider Business Mailing Address
First Line : 115 MAIN ST STE 2D
Second Line :
City : NORTH EASTON
State : MA
Zip : 02356-1469
Country : US
Telephone Number : 508-238-7766
Fax Number : 508-230-5089
Provider Business Practice Location Address
First Line : 115 MAIN ST STE 2D
Second Line :
City : NORTH EASTON
State : MA
Zip : 02356-1469
Country : US
Telephone Number : 508-238-7766
Fax Number : 508-230-5089
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2006
Last Update Date : 10/18/2010

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