Provider Demographics
NPI:1821030677
Name:CARLSON, CRAIG WILLIAM (PHD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:WILLIAM
Last Name:CARLSON
Suffix:
Gender:M
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:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92018-0098
Mailing Address - Country:US
Mailing Address - Phone:760-758-5680
Mailing Address - Fax:858-755-2359
Practice Address - Street 1:12625 HIGH BLUFF DR
Practice Address - Street 2:SUITE 114-C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2052
Practice Address - Country:US
Practice Address - Phone:760-758-5680
Practice Address - Fax:858-755-2359
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 10849103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWCP10849AMedicare ID - Type UnspecifiedPPIN