MEDICARE: CRAIG CARLSON, PH.D., PSYCHOLOGIST, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY10849	CA

General Provider Information

NPI Number	:	1447298369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAIG CARLSON, PH.D., PSYCHOLOGIST, INC.

Provider Business Mailing Address
First Line	:	PO BOX 98
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92018-0098
Country	:	US
Telephone Number	:	760-494-0089
Fax Number	:	858-755-2359

Provider Business Practice Location Address
First Line	:	12625 HIGH BLUFF DR
Second Line	:	SUITE 114-C
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2052
Country	:	US
Telephone Number	:	760-494-0089
Fax Number	:	858-755-2359

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CRAIG WILLIAM CARLSON
Credential	:	PH.D.
Telephone Number	:	760-758-5680

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	08/22/2020

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