Provider Demographics
NPI:1326464876
Name:PRASAD-CARNAHAN, POONAM (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:POONAM
Middle Name:
Last Name:PRASAD-CARNAHAN
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3110
Mailing Address - Country:US
Mailing Address - Phone:916-519-5214
Mailing Address - Fax:
Practice Address - Street 1:1000 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4099
Practice Address - Country:US
Practice Address - Phone:510-434-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA274021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical