Provider Demographics
NPI:1366476277
Name:CARLE, MICHAEL JOHN (MSSW LICSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
Last Name:CARLE
Suffix:
Gender:M
Credentials:MSSW LICSW
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Mailing Address - Street 1:1900 SILVER LAKE RD NW
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1786
Mailing Address - Country:US
Mailing Address - Phone:651-628-9566
Mailing Address - Fax:651-628-0411
Practice Address - Street 1:9075 QUADAY AVE NE
Practice Address - Street 2:SUITE 102
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-6672
Practice Address - Country:US
Practice Address - Phone:763-746-9492
Practice Address - Fax:763-746-3685
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN7229104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN536557100Medicaid
MN800002076Medicare Oscar/Certification