Healthcare Provider Details

I. General information

NPI: 1356265110
Provider Name (Legal Business Name): PETER CARLIN LGSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2736 HENNEPIN AVE
MINNEAPOLIS MN
55408-1037
US

IV. Provider business mailing address

2736 HENNEPIN AVE
MINNEAPOLIS MN
55408-1037
US

V. Phone/Fax

Practice location:
  • Phone: 651-769-5029
  • Fax:
Mailing address:
  • Phone: 651-769-5029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: