Provider Demographics
NPI:1619175205
Name:CARLSON, BRIDGET MARIE III
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:MARIE
Last Name:CARLSON
Suffix:III
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 FRANCISCAN CT UNIT 11
Mailing Address - Street 2:
Mailing Address - City:CARPINTERIA
Mailing Address - State:CA
Mailing Address - Zip Code:93013-1255
Mailing Address - Country:US
Mailing Address - Phone:818-271-7658
Mailing Address - Fax:
Practice Address - Street 1:222 W VALERIO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2930
Practice Address - Country:US
Practice Address - Phone:805-569-2785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health