Provider Demographics
NPI:1689408593
Name:FOSTER, CARMEANN (LICSW)
Entity type:Individual
Prefix:
First Name:CARMEANN
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 EARLE BROWN DR STE 230
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-4107
Mailing Address - Country:US
Mailing Address - Phone:612-615-9821
Mailing Address - Fax:612-605-0046
Practice Address - Street 1:6120 EARLE BROWN DR STE 230
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-4107
Practice Address - Country:US
Practice Address - Phone:612-615-9821
Practice Address - Fax:612-605-0046
Is Sole Proprietor?:No
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN192841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical