Provider Demographics
NPI:1093956484
Name:CARLSON, LYNNE MARIE (LICSW)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:MARIE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CONCORDIA DR
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-2062
Mailing Address - Country:US
Mailing Address - Phone:978-518-2942
Mailing Address - Fax:
Practice Address - Street 1:6 CONCORDIA DR
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-2062
Practice Address - Country:US
Practice Address - Phone:978-518-2942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1104671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical