Provider Demographics
NPI:1497887483
Name:SIDDIQI, CARMEN LOUISE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:LOUISE
Last Name:SIDDIQI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 S BROADWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6662
Mailing Address - Country:US
Mailing Address - Phone:805-925-5776
Mailing Address - Fax:805-614-7126
Practice Address - Street 1:920 S BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6662
Practice Address - Country:US
Practice Address - Phone:805-925-5776
Practice Address - Fax:805-614-7126
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 5631101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health