Provider Demographics
NPI:1033487376
Name:GARDEN, CAROLINE CLARK (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:CLARK
Last Name:GARDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:KELLY
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:P-LCSW
Mailing Address - Street 1:11627 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-2210
Mailing Address - Country:US
Mailing Address - Phone:850-291-4714
Mailing Address - Fax:
Practice Address - Street 1:11627 E 25TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-2210
Practice Address - Country:US
Practice Address - Phone:850-291-4714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2023-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW131431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3410049Medicaid