Healthcare Provider Details

I. General information

NPI: 1700611605
Provider Name (Legal Business Name): JOSEPHINE MARIE CARLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 CENTRAL AVE
NEEDHAM MA
02492-1410
US

IV. Provider business mailing address

104 SEWALL AVE APT 2
BROOKLINE MA
02446-5310
US

V. Phone/Fax

Practice location:
  • Phone: 781-292-2196
  • Fax: 781-292-2197
Mailing address:
  • Phone: 951-321-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: