Provider Demographics
NPI:1114788015
Name:CARLSEN, ANGELICA LEANNE (ASW)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:LEANNE
Last Name:CARLSEN
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 CHESTNUT ST APT 107
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-2747
Mailing Address - Country:US
Mailing Address - Phone:714-873-6369
Mailing Address - Fax:
Practice Address - Street 1:1575 OLD BAYSHORE HWY STE 205
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1616
Practice Address - Country:US
Practice Address - Phone:669-200-2709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1215681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical