Provider Demographics
NPI:1033349659
Name:SORENSON, CARL JASON (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:JASON
Last Name:SORENSON
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1568
Mailing Address - Street 2:
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-1568
Mailing Address - Country:US
Mailing Address - Phone:435-612-0788
Mailing Address - Fax:
Practice Address - Street 1:81 N 300 E
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2419
Practice Address - Country:US
Practice Address - Phone:435-612-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT661756635011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical