Provider Demographics
NPI:1053443838
Name:CARAKER, PAOLA BEATRIZ (LMFT)
Entity Type:Individual
Prefix:MS
First Name:PAOLA
Middle Name:BEATRIZ
Last Name:CARAKER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:PAOLA
Other - Middle Name:BEATRIZ
Other - Last Name:KERNEUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT INTERN
Mailing Address - Street 1:449 N. MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93737
Mailing Address - Country:US
Mailing Address - Phone:559-304-8557
Mailing Address - Fax:844-965-9225
Practice Address - Street 1:6777 N. WILLOW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710
Practice Address - Country:US
Practice Address - Phone:559-304-8557
Practice Address - Fax:844-965-9225
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 42877106H00000X
CAMFC45183106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAIMF 42877OtherBBS LICENSE #