Provider Demographics
NPI:1154474864
Name:CARSEN, MARJORIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:
Last Name:CARSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 ALLEN BROOK LN
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-9303
Mailing Address - Country:US
Mailing Address - Phone:802-876-4000
Mailing Address - Fax:802-876-4001
Practice Address - Street 1:188 ALLEN BROOK LN
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-9303
Practice Address - Country:US
Practice Address - Phone:802-876-4000
Practice Address - Fax:802-876-4001
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-00096882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT38462OtherBCBS
VT0VN1764Medicaid
VTVN1764Medicare ID - Type Unspecified
VT38462OtherBCBS