Provider Demographics
NPI:1013246628
Name:KARLSSON, ROGER PER-ERIK (PHD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:PER-ERIK
Last Name:KARLSSON
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 EAST CAMPBELL AVENUE
Mailing Address - Street 2:STE 170
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2001
Mailing Address - Country:US
Mailing Address - Phone:510-847-5592
Mailing Address - Fax:
Practice Address - Street 1:51 EAST CAMPBELL AVENUE
Practice Address - Street 2:STE 170
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2001
Practice Address - Country:US
Practice Address - Phone:510-847-5592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21331103TF0200X, 103TP0814X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis