Provider Demographics
NPI:1720296601
Name:CARLSON, SUSAN (MSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WENTWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-2742
Mailing Address - Country:US
Mailing Address - Phone:513-821-9707
Mailing Address - Fax:513-821-9707
Practice Address - Street 1:210 WENTWORTH AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-2742
Practice Address - Country:US
Practice Address - Phone:513-821-3200
Practice Address - Fax:513-821-9707
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00031471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical