Provider Demographics
NPI:1649495706
Name:CARSON, ANNMARIE (LMFT)
Entity type:Individual
Prefix:
First Name:ANNMARIE
Middle Name:
Last Name:CARSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1644
Mailing Address - Country:US
Mailing Address - Phone:203-522-4554
Mailing Address - Fax:203-413-1587
Practice Address - Street 1:31 CHERRY ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3414
Practice Address - Country:US
Practice Address - Phone:203-522-4554
Practice Address - Fax:203-413-1587
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001151106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist