Individual provider Active NPI

Richard E Carlson, PH.D.

  • Clinical Psychologist
  • Hanover, PA
National Provider Identifier
1972529659
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PA-3604-L Issued in PA
Practice address
401 Allegheny Ave
Hanover, PA 17331-1949
Phone
(717) 632-3886
NPI assigned
Jul 14, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PA-3604-L PA Primary

Addresses

Primary practice location

401 Allegheny Ave
Hanover, PA 17331-1949

Mailing address

5 Sheridan Dr
Hanover, PA 17331-9323

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120106000319 PA Practitioner - Clinical Psychologist 6709052194 Practice locations: Hanover, PA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

401 Allegheny Ave
Hanover, PA 17331-1957
Phone (717) 632-3886

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PA-3604-LPAMDClinical Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972529659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 SHERIDAN DR",
            "city": "HANOVER",
            "state": "PA",
            "postal_code": "173319323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 ALLEGHENY AVE",
            "city": "HANOVER",
            "state": "PA",
            "postal_code": "173311949",
            "telephone_number": "717-632-3886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "RICHARD",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PA-3604-L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hanover, PA

Sources for this page

Verify at the official NPI Registry.