Active NPI
John V. Carlson, PH.D.
- Clinical Psychologist
- Hartford, CT
National Provider Identifier
1396005989
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 003138
- Practice address
- 300 Summit St
Hartford, CT 06106-3100 - Phone
- (860) 305-3024
- NPI assigned
- May 17, 2012
- Last updated
- May 17, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 003138 | CT | Primary |
Addresses
Primary practice location
300 Summit St
Hartford, CT 06106-3100
Mailing address
10 Avondale Rd
Manchester, CT 06042-3258
Phone (860) 305-3024
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003138 | CT | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1337212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337212800000",
"number": "1396005989",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 AVONDALE RD",
"city": "MANCHESTER",
"state": "CT",
"postal_code": "060423258",
"telephone_number": "860-305-3024"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 SUMMIT ST",
"city": "HARTFORD",
"state": "CT",
"postal_code": "061063100",
"telephone_number": "860-305-3024"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "JOHN",
"middle_name": "V.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-05-17",
"last_updated": "2012-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CT",
"license": "003138",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hartford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.