Provider Demographics
NPI:1790130532
Name:CARLSON, ERIC (LMHC CASAC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:CARLSON
Suffix:
Gender:M
Credentials:LMHC CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2286 ROUTE 32 APT B
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-4806
Mailing Address - Country:US
Mailing Address - Phone:518-857-7313
Mailing Address - Fax:
Practice Address - Street 1:2286 ROUTE 32 APT B
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-4806
Practice Address - Country:US
Practice Address - Phone:518-857-7313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007136101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional