Provider Demographics
NPI:1083127351
Name:CARLSON, KATHERINE ANNE (MSW, LISW-S, CDCA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MSW, LISW-S, CDCA
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:ANNE
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LISW-S, CDCA
Mailing Address - Street 1:2123 AUBURN AVE STE 428
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-585-0635
Mailing Address - Fax:513-585-0775
Practice Address - Street 1:2123 AUBURN AVE STE 428
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-585-0635
Practice Address - Fax:513-585-0775
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1901787-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0263242Medicaid
OHI.1901787-SUPVOtherOHIO COUNSELOR, SOCIAL WORK, AND MARRIAGE AND FAMILY THERAPIST BOARD