Basic Information
| Provider Information | |||||||||
| NPI: | 1720222417 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARLSON & ASSOCIATES A PSYCHOLOGY CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 457 | ||||||||
| Address2: | |||||||||
| City: | SAN DIMAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917730457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099719334 | ||||||||
| FaxNumber: | 9099719654 | ||||||||
| Practice Location | |||||||||
| Address1: | 2810 E DEL MAR BLVD STE 12 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911076709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265850041 | ||||||||
| FaxNumber: | 6265851839 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2009 | ||||||||
| LastUpdateDate: | 04/24/2009 | ||||||||
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| AuthorizedOfficialLastName: | CARLSON | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6265850041 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.