| Doctor Name: | KAVITA CARLSON |
| NPI Number: | 1013068816 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 1099 |
| Business Practice Address: | 2680 Vernon Dr Green Bay, WI - 543045374 |
| Business Phone Number: | 9204964700 |
| Business Fax Number: | |
| Mailing Address: | 2680 Vernon Dr, GREEN BAY |
| State: | WI |
| Postal Code: | 543045374 |
| Phone Number: | 9204964700 |
| Fax Number: | |
| NPI Enumeration Date: | 01/16/2007 |
| NPI Last Update Date: | 03/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 1099 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |