Provider Demographics
NPI:1184637860
Name:CARRILLO, EDWARD VELASCO (LCSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:VELASCO
Last Name:CARRILLO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8810 RIO SAN DIEGO DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1622
Mailing Address - Country:US
Mailing Address - Phone:858-518-7107
Mailing Address - Fax:619-400-5159
Practice Address - Street 1:8810 RIO SAN DIEGO DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1622
Practice Address - Country:US
Practice Address - Phone:858-518-7107
Practice Address - Fax:619-400-5159
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS138761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical