Provider Demographics
NPI:1508969841
Name:CAREY, DANA Y (MSW, PPS)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:Y
Last Name:CAREY
Suffix:
Gender:F
Credentials:MSW, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 330
Mailing Address - Street 2:12755 NORTH HIGHWAY 88
Mailing Address - City:VICTOR
Mailing Address - State:CA
Mailing Address - Zip Code:95253
Mailing Address - Country:US
Mailing Address - Phone:209-340-5800
Mailing Address - Fax:209-340-5804
Practice Address - Street 1:12755 N HIGHWAY 88
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-9323
Practice Address - Country:US
Practice Address - Phone:209-340-5800
Practice Address - Fax:209-340-5804
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA398113Medicaid