Healthcare Provider Details

I. General information

NPI: 1275635021
Provider Name (Legal Business Name): CAROL LEONARD SOBELSON MS, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 E SIDE DR
CONCORD NH
03301-5465
US

IV. Provider business mailing address

141 E SIDE DR
CONCORD NH
03301-5465
US

V. Phone/Fax

Practice location:
  • Phone: 603-724-3496
  • Fax: 603-228-7014
Mailing address:
  • Phone: 603-724-3496
  • Fax: 603-228-7014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number88
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: