Provider Demographics
NPI:1154683308
Name:CARRASCO, EDNA LILA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EDNA
Middle Name:LILA
Last Name:CARRASCO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EDNA
Other - Middle Name:L
Other - Last Name:OCHOA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7300 WYNDHAM DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-4913
Mailing Address - Country:US
Mailing Address - Phone:916-525-6714
Mailing Address - Fax:916-525-6188
Practice Address - Street 1:7300 WYNDHAM DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-4913
Practice Address - Country:US
Practice Address - Phone:916-525-6714
Practice Address - Fax:916-525-6188
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical