Provider Demographics
NPI:1376082511
Name:CARLSON, JAMES
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:CARLSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BRAEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01835-8110
Mailing Address - Country:US
Mailing Address - Phone:978-764-1649
Mailing Address - Fax:
Practice Address - Street 1:5 BRAEWOOD DR
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:MA
Practice Address - Zip Code:01835-8110
Practice Address - Country:US
Practice Address - Phone:978-764-1649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor