Healthcare Provider Details

I. General information

NPI: 1346651973
Provider Name (Legal Business Name): LYNN CARLSEN LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2014
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 CONNECTICUT AVE 500
KENSINGTON MD
20895-3910
US

IV. Provider business mailing address

10400 CONNECTICUT AVE 500
KENSINGTON MD
20895-3910
US

V. Phone/Fax

Practice location:
  • Phone: 202-360-4787
  • Fax: 202-360-4787
Mailing address:
  • Phone: 202-360-4787
  • Fax: 202-360-4787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17937
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: