Provider Demographics
NPI:1306925094
Name:CARLSEN, LUCY MORAEN (LICSW)
Entity type:Individual
Prefix:MRS
First Name:LUCY
Middle Name:MORAEN
Last Name:CARLSEN
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:PO BOX 1095
Mailing Address - Street 2:
Mailing Address - City:EASTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02642-1095
Mailing Address - Country:US
Mailing Address - Phone:774-722-2844
Mailing Address - Fax:
Practice Address - Street 1:10 MARY CHASE ROAD
Practice Address - Street 2:
Practice Address - City:EASTHAM
Practice Address - State:MA
Practice Address - Zip Code:02642
Practice Address - Country:US
Practice Address - Phone:508-240-1587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1061631041C0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACAP04217OtherBLUE CROSS BLUE SHIELD
113774OtherVALUE OPTIONS NORTHEAST
CAP04217Medicare ID - Type Unspecified