MEDICARE: MS. DEBORAH OBOYSKI CARLSEN LMSW

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	1041C0700X	Clinical Social Worker	065262	NY

General Provider Information

NPI Number	:	1861454589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH OBOYSKI CARLSEN LMSW

Provider Business Mailing Address
First Line	:	107 ACHILLES LN
Second Line	:
City	:	GALWAY
State	:	NY
Zip	:	12074-2723
Country	:	US
Telephone Number	:	151-888-2694
Fax Number	:

Provider Business Practice Location Address
First Line	:	11-21 BROADWAY ST
Second Line	:
City	:	GLOVERSVILLE
State	:	NY
Zip	:	12078-3968
Country	:	US
Telephone Number	:	151-872-5431
Fax Number	:	518-725-2556

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	07/08/2007

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