Provider Demographics
NPI:1518386259
Name:CARLSON, JENNIFER (LCSW14538)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LCSW14538
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 SHETLAND CIR
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-1631
Mailing Address - Country:US
Mailing Address - Phone:941-726-2326
Mailing Address - Fax:
Practice Address - Street 1:601 SHETLAND CIR
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-1631
Practice Address - Country:US
Practice Address - Phone:941-726-2326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW 3590104100000X, 1041C0700X, 1041S0200X
FLLCSW145381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool