Healthcare Provider Details

I. General information

NPI: 1952704306
Provider Name (Legal Business Name): JOSHUA EDWARD CARLSON PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 03/18/2021
Certification Date: 02/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 LAFAYETTE RD # 217
NORTH HAMPTON NH
03862-2451
US

IV. Provider business mailing address

45 LAFAYETTE RD # 217
NORTH HAMPTON NH
03862-2451
US

V. Phone/Fax

Practice location:
  • Phone: 603-703-5086
  • Fax:
Mailing address:
  • Phone: 603-703-5086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1522
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY32105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: