Individual
KAVITA CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2680 VERNON DR, GREEN BAY, WI 54304-5374
(920) 496-4700
Mailing address
PO BOX 19070, GREEN BAY, WI 54307-9070
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1099
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39665200
—
WI
01
—
396947235002
BLUE CROSS
WI
Enumeration date
01/16/2007
Last updated
09/16/2016
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