Provider Demographics
NPI:1093025579
Name:SIDHU, CAROLYN JOSEPHINE
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JOSEPHINE
Last Name:SIDHU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOSIE
Other - Middle Name:
Other - Last Name:SIDHU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1288 SUNGLOW DRIVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056
Mailing Address - Country:US
Mailing Address - Phone:760-805-5317
Mailing Address - Fax:
Practice Address - Street 1:2204 EL CAMINO REAL
Practice Address - Street 2:SUITE 310
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054
Practice Address - Country:US
Practice Address - Phone:760-805-5317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48980106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist