Provider Demographics
NPI:1518035989
Name:SPEARS, CAROLYN E (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:E
Last Name:SPEARS
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 1:5440 PALISADES DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-4529
Mailing Address - Country:US
Mailing Address - Phone:503-703-1402
Mailing Address - Fax:
Practice Address - Street 1:132 NE 15TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-2210
Practice Address - Country:US
Practice Address - Phone:503-703-1402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR132610Medicare PIN