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NPI Code Detail

MEDICARE: DR. CARA L CARLSON MSW. LICSW

MEDICARE:  DR. CARA L CARLSON  MSW. 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 Worker8909

General Provider Information

NPI Number : 1578696845
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARA L CARLSON MSW. LICSW
Provider Business Mailing Address
First Line : 3646 14TH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-2712
Country : US
Telephone Number : 612-462-3812
Fax Number :
Provider Business Practice Location Address
First Line : 3646 14TH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-2712
Country : US
Telephone Number : 612-462-3812
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2007
Last Update Date : 05/01/2015

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