Provider Demographics
NPI:1356416069
Name:MEISELMAN, KARIN CARLSON (PHD)
Entity type:Individual
Prefix:DR
First Name:KARIN
Middle Name:CARLSON
Last Name:MEISELMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 E COLORADO BLVD
Mailing Address - Street 2:SUITE 318
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2039
Mailing Address - Country:US
Mailing Address - Phone:626-792-6718
Mailing Address - Fax:626-794-4356
Practice Address - Street 1:595 E COLORADO BLVD
Practice Address - Street 2:SUITE 318
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2039
Practice Address - Country:US
Practice Address - Phone:626-792-6718
Practice Address - Fax:626-794-4356
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4112103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP4112Medicare ID - Type Unspecified
CAR14321Medicare UPIN