Robert Ryan Carlson, LPC

Key facts

NPI

1548093412

Entity type

Individual (NPI type 1)

Primary specialty

Professional Counselor 101YP2500X

License

007534 (CT)

Practice address

392 Merrow Rd
Tolland, CT 06084-3974

Phone

(860) 830-7838

Fax

(860) 454-0667

NPI assigned

Aug 24, 2024

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

Other names

• Ryan Carlson Other name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 24, 2024.

{
    "created_epoch": "1724457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724457600000",
    "number": "1548093412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 SUSAN DR",
            "city": "TOLLAND",
            "state": "CT",
            "postal_code": "060842537",
            "telephone_number": "860-836-1497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "392 MERROW RD",
            "city": "TOLLAND",
            "state": "CT",
            "postal_code": "060843974",
            "telephone_number": "860-830-7838",
            "fax_number": "860-454-0667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "ROBERT",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-24",
        "last_updated": "2024-08-24",
        "certification_date": "2024-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "007534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RYAN",
            "last_name": "CARLSON",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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