Provider Demographics
NPI:1427593607
Name:CARR, DYLAN ROSE (MSW)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:ROSE
Last Name:CARR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 W SUNSET WAY APT C203
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-3163
Mailing Address - Country:US
Mailing Address - Phone:818-312-7028
Mailing Address - Fax:
Practice Address - Street 1:340 W SUNSET WAY APT C203
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3163
Practice Address - Country:US
Practice Address - Phone:818-312-7028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health