Provider Demographics
NPI:1407907876
Name:BERG HANSON, CARLOTTA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CARLOTTA
Middle Name:
Last Name:BERG HANSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 MILL PLAIN RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-5181
Mailing Address - Country:US
Mailing Address - Phone:293-797-8222
Mailing Address - Fax:203-744-5550
Practice Address - Street 1:36 MILL PLAIN RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-5181
Practice Address - Country:US
Practice Address - Phone:293-797-8222
Practice Address - Fax:203-744-5550
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0043081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT166264OtherPROVIDER ID
CT235767OtherPROVIDER ID