Provider Demographics
NPI:1306018460
Name:CARLSON, ELIZABETH ANN (LAC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:139 FULTON ST
Mailing Address - Street 2:SUITE 1012
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-2594
Mailing Address - Country:US
Mailing Address - Phone:646-823-4244
Mailing Address - Fax:
Practice Address - Street 1:139 FULTON ST
Practice Address - Street 2:SUITE 1012
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-2594
Practice Address - Country:US
Practice Address - Phone:646-823-4244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-29
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25003665171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist