Provider Demographics
NPI:1275635021
Name:SOBELSON, CAROL LEONARD (MS, LICSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LEONARD
Last Name:SOBELSON
Suffix:
Gender:F
Credentials:MS, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E SIDE DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5465
Mailing Address - Country:US
Mailing Address - Phone:603-724-3496
Mailing Address - Fax:603-228-7014
Practice Address - Street 1:141 E SIDE DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5465
Practice Address - Country:US
Practice Address - Phone:603-724-3496
Practice Address - Fax:603-228-7014
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH88101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1036802OtherCIGNA
NH80001295Medicaid
NH1403519Y0NH01OtherANTHEM BC/BS NH
NH1036802OtherCIGNA
NHRE1295Medicare ID - Type Unspecified