Provider Demographics
NPI:1144219072
Name:HARRIS, CAROLE ANNE (LCSW, PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:ANNE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18381 GOLDENWEST ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1107
Mailing Address - Country:US
Mailing Address - Phone:714-842-7777
Mailing Address - Fax:714-842-7774
Practice Address - Street 1:18381 GOLDENWEST ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1107
Practice Address - Country:US
Practice Address - Phone:714-842-7777
Practice Address - Fax:714-842-7774
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS184211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW18421Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER