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General NPI Number Information
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NPI Number | 1447298369
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Entity Type | Organization
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Legal Business Name | CRAIG CARLSON, PH.D., PSYCHOLOGIST, INC.
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12625 HIGH BLUFF DR SUITE 114-C
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City | SAN DIEGO
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State | CA
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Zip | 92130-2052
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Country | US
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Telephone | 760-494-0089
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Fax | 858-755-2359
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Provider Business Mailing Address
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Address Line | PO BOX 98
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City | CARLSBAD
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State | CA
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Zip | 92018-0098
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Country | US
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Telephone | 760-494-0089
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Fax | 858-755-2359
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CRAIG WILLIAM CARLSON
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Credential | PH.D.
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Telephone | 760-758-5680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY10849
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License Number State | CA
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