Provider Demographics
NPI:1225373285
Name:CARLSON, KAREN TERESA (LAC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:TERESA
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 UNION SQ E
Mailing Address - Street 2:SUITE 615 NORTH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3209
Mailing Address - Country:US
Mailing Address - Phone:603-568-1287
Mailing Address - Fax:
Practice Address - Street 1:32 UNION SQ E
Practice Address - Street 2:SUITE 615 NORTH
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3209
Practice Address - Country:US
Practice Address - Phone:603-568-1287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25 004895171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist