Healthcare Provider Details

I. General information

NPI: 1639223720
Provider Name (Legal Business Name): VICTOR BRYAN CARLSON PSYD LCADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 NEWTON SPARTA RD
NEWTON NJ
07860
US

IV. Provider business mailing address

64 SMITH RD
DENVILLE NJ
07834
US

V. Phone/Fax

Practice location:
  • Phone: 973-229-4209
  • Fax:
Mailing address:
  • Phone: 973-328-4506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00304300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number37LC00080400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: