Provider Demographics
NPI:1801908066
Name:CARSON, BARBARA LYNN (MSW LICSW)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:LYNN
Last Name:CARSON
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ALGONQUIAN DR
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760
Mailing Address - Country:US
Mailing Address - Phone:508-651-1162
Mailing Address - Fax:
Practice Address - Street 1:409 FORTUNE BLVD
Practice Address - Street 2:STE 101
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757
Practice Address - Country:US
Practice Address - Phone:508-473-7400
Practice Address - Fax:781-235-3907
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103694104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP02709Medicare ID - Type Unspecified