Healthcare Provider Details

I. General information

NPI: 1790130532
Provider Name (Legal Business Name): ERIC CARLSON LMHC CASAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 01/01/2024
Certification Date: 01/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2286 ROUTE 32 APT B
SAUGERTIES NY
12477-4806
US

IV. Provider business mailing address

2286 ROUTE 32 APT B
SAUGERTIES NY
12477-4806
US

V. Phone/Fax

Practice location:
  • Phone: 518-857-7313
  • Fax:
Mailing address:
  • Phone: 518-857-7313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number007136
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number007136
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: