Healthcare Provider Details

I. General information

NPI: 1861454589
Provider Name (Legal Business Name): DEBORAH OBOYSKI CARLSEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11-21 BROADWAY ST
GLOVERSVILLE NY
12078-3968
US

IV. Provider business mailing address

107 ACHILLES LN
GALWAY NY
12074-2723
US

V. Phone/Fax

Practice location:
  • Phone: 151-872-5431
  • Fax: 518-725-2556
Mailing address:
  • Phone: 151-888-2694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number065262
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: