Healthcare Provider Details

I. General information

NPI: 1710074810
Provider Name (Legal Business Name): SUSAN M. CARSON L.I.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 S LIBERTY ST
POWELL OH
43065-9301
US

IV. Provider business mailing address

97 S LIBERTY ST
POWELL OH
43065-9301
US

V. Phone/Fax

Practice location:
  • Phone: 614-781-1340
  • Fax: 614-841-1567
Mailing address:
  • Phone: 614-781-1340
  • Fax: 614-841-1567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-0005655
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: