Healthcare Provider Details

I. General information

NPI: 1982643847
Provider Name (Legal Business Name): DEBORAH S CARLSON PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5427 COMMERCIAL WAY
SPRING HILL FL
34606
US

IV. Provider business mailing address

5427 COMMERCIAL WAY
SPRING HILL FL
34606
US

V. Phone/Fax

Practice location:
  • Phone: 352-592-2392
  • Fax: 352-592-2394
Mailing address:
  • Phone: 352-592-2392
  • Fax: 352-592-2394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW6456
License Number StateFL

VIII. Authorized Official

Name: DEBORAH CARLSON
Title or Position: LCSW
Credential:
Phone: 352-592-2392