Healthcare Provider Details

I. General information

NPI: 1720222417
Provider Name (Legal Business Name): CARLSON & ASSOCIATES A PSYCHOLOGY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 E DEL MAR BLVD STE 12
PASADENA CA
91107-6709
US

IV. Provider business mailing address

PO BOX 457
SAN DIMAS CA
91773-0457
US

V. Phone/Fax

Practice location:
  • Phone: 626-585-0041
  • Fax: 626-585-1839
Mailing address:
  • Phone: 909-971-9334
  • Fax: 909-971-9654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. BARBARA CARLSON
Title or Position: PRESIDENT
Credential: PHD
Phone: 626-585-0041