Healthcare Provider Details

I. General information

NPI: 1376465278
Provider Name (Legal Business Name): JOSEPH CARLSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1938 E LINCOLN HWY STE 207
NEW LENOX IL
60451-3831
US

IV. Provider business mailing address

1938 E LINCOLN HWY STE 207
NEW LENOX IL
60451-3831
US

V. Phone/Fax

Practice location:
  • Phone: 708-512-7709
  • Fax:
Mailing address:
  • Phone: 708-512-7709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.041262
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: