Provider Demographics
NPI:1184834632
Name:CARSOLA, JANET GRAVES (MFT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:GRAVES
Last Name:CARSOLA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:GRAVES
Other - Last Name:CARSOLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, MFT, CAC
Mailing Address - Street 1:924 NINTH STREET
Mailing Address - Street 2:APT. 8
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403
Mailing Address - Country:US
Mailing Address - Phone:310-393-4394
Mailing Address - Fax:
Practice Address - Street 1:2566 OVERLAND AVE
Practice Address - Street 2:500 A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-3366
Practice Address - Country:US
Practice Address - Phone:310-281-1968
Practice Address - Fax:310-737-0911
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT35870106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist