Provider Demographics
NPI:1265743314
Name:CARLSON, KURT ERIK (MA, BCBA, LBA, LABA)
Entity type:Individual
Prefix:MR
First Name:KURT
Middle Name:ERIK
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MA, BCBA, LBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:RI
Mailing Address - Zip Code:02826-0095
Mailing Address - Country:US
Mailing Address - Phone:401-651-6556
Mailing Address - Fax:
Practice Address - Street 1:491 KILVERT ST
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1370
Practice Address - Country:US
Practice Address - Phone:401-618-6991
Practice Address - Fax:401-618-6995
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-09-3696103K00000X
RI1-16-24040103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst