Provider Demographics
NPI:1346366440
Name:CARLTON, LUCYANN (MS, PSYD)
Entity Type:Individual
Prefix:DR
First Name:LUCYANN
Middle Name:
Last Name:CARLTON
Suffix:
Gender:F
Credentials:MS, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PACIFICA
Mailing Address - Street 2:SUITE 273
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3310
Mailing Address - Country:US
Mailing Address - Phone:949-341-0382
Mailing Address - Fax:949-341-0349
Practice Address - Street 1:111 PACIFICA
Practice Address - Street 2:SUITE 270
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3310
Practice Address - Country:US
Practice Address - Phone:949-341-0382
Practice Address - Fax:949-341-0349
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34045106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist