Healthcare Provider Details

I. General information

NPI: 1013246628
Provider Name (Legal Business Name): ROGER PER-ERIK KARLSSON PH.D., ABPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 EAST CAMPBELL AVENUE STE 170
CAMPBELL CA
95008-2001
US

IV. Provider business mailing address

51 EAST CAMPBELL AVENUE STE 170
CAMPBELL CA
95008-2001
US

V. Phone/Fax

Practice location:
  • Phone: 510-847-5592
  • Fax:
Mailing address:
  • Phone: 510-847-5592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number21331
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number21331
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number21331
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: