Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 35SI00304300 | NJ |
N | 103T00000X | Psychologist | 35SI00304300 | NJ |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 37LC00080400 | NJ |
NPI | 1639223720 |
---|---|
Provider Name | Dr. Victor Bryan Carlson |
First Address | Denville, NJ 07834 |
Second Address | Newton, NJ 07860 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |