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NPI Code Detail

MEDICARE: MRS. DIANA GOUVEIA CARLSON LICSW

MEDICARE: MRS. DIANA GOUVEIA CARLSON LICSW
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
11041C0700XClinical Social Worker114804MA

General Provider Information

NPI Number : 1558307843
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DIANA GOUVEIA CARLSON LICSW
Provider Business Mailing Address
First Line : 41 LANCASTER DR
Second Line :
City : TEWKSBURY
State : MA
Zip : 01876-1322
Country : US
Telephone Number : 978-851-7057
Fax Number :
Provider Business Practice Location Address
First Line : 21 GLEN AVE
Second Line : SUITE 3
City : CHELMSFORD
State : MA
Zip : 01824-2858
Country : US
Telephone Number : 978-256-0667
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2006
Last Update Date : 05/17/2011

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