Provider Demographics
NPI:1821185323
Name:CARSON, LAURA RUTH (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:RUTH
Last Name:CARSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SATUIT TRL
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-3727
Mailing Address - Country:US
Mailing Address - Phone:781-544-0220
Mailing Address - Fax:
Practice Address - Street 1:175 DERBY STREET
Practice Address - Street 2:SUITE 16
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-0212
Practice Address - Country:US
Practice Address - Phone:781-740-1546
Practice Address - Fax:781-740-0212
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1100581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P07686Medicare ID - Type Unspecified