Healthcare Provider Details

I. General information

NPI: 1821185323
Provider Name (Legal Business Name): LAURA RUTH CARSON LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 DERBY STREET SUITE 16
HINGHAM MA
02043-0212
US

IV. Provider business mailing address

10 SATUIT TRL
SCITUATE MA
02066-3727
US

V. Phone/Fax

Practice location:
  • Phone: 781-740-1546
  • Fax: 781-740-0212
Mailing address:
  • Phone: 781-544-0220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110058
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: