Healthcare Provider Details

I. General information

NPI: 1053515510
Provider Name (Legal Business Name): LORIN CARLSON-HEALY RN, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORIN CARLSON

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E KING ST APT 224
MALVERN PA
19355-2543
US

IV. Provider business mailing address

233 E KING ST APT 224
MALVERN PA
19355-2543
US

V. Phone/Fax

Practice location:
  • Phone: 914-467-0866
  • Fax:
Mailing address:
  • Phone: 914-467-0866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN637123
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR036388
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW020770
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: