Provider Demographics
NPI:1326112228
Name:WADSWORTH, CAROLE NOTA (MFT)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:NOTA
Last Name:WADSWORTH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6205 SHASTA PL
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-4422
Mailing Address - Country:US
Mailing Address - Phone:805-630-7212
Mailing Address - Fax:805-389-0296
Practice Address - Street 1:400 ROSEWOOD AVE
Practice Address - Street 2:STE.102
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5932
Practice Address - Country:US
Practice Address - Phone:805-630-7212
Practice Address - Fax:805-389-0296
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25920106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist