Basic Information
| Provider Information | |||||||||
| NPI: | 1114165818 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARSON | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | ELIZE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 467 | ||||||||
| Address2: | |||||||||
| City: | TAHOE CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 961450467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075040760 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 67 EUSTIS PKWY | ||||||||
| Address2: | |||||||||
| City: | WATERVILLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049015173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078732136 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2009 | ||||||||
| LastUpdateDate: | 03/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 114726 | MA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LC17108 | ME | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.