Provider Demographics
NPI:1184750457
Name:CARLSEN, LORI ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:CARLSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5747
Mailing Address - Country:US
Mailing Address - Phone:732-219-9393
Mailing Address - Fax:732-219-9006
Practice Address - Street 1:81 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5747
Practice Address - Country:US
Practice Address - Phone:732-219-9393
Practice Address - Fax:732-219-9006
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC046675001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ754131Medicare PIN