Provider Demographics
NPI:1760503742
Name:CARLSON, JANICE BRACALENTE (MSW)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:BRACALENTE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5570 STERRETT PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2641
Mailing Address - Country:US
Mailing Address - Phone:410-730-0552
Mailing Address - Fax:410-715-4720
Practice Address - Street 1:5570 STERRETT PL
Practice Address - Street 2:SUITE 101
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2641
Practice Address - Country:US
Practice Address - Phone:410-730-0552
Practice Address - Fax:410-715-4720
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD073281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD146L365SMedicare ID - Type Unspecified