Provider Demographics
NPI:1538705231
Name:CARLSON, GRETA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GRETA
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 S PARK AVE APT 502
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-3635
Mailing Address - Country:US
Mailing Address - Phone:301-938-8431
Mailing Address - Fax:
Practice Address - Street 1:2 WISCONSIN CIR STE 915
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-7036
Practice Address - Country:US
Practice Address - Phone:301-938-8431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810007878103T00000X
MD06762103T00000X, 103T00000X
DCPSY200001358103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist