Provider Demographics
NPI:1609071026
Name:O'TOOLE, CORRIE ANNE (MSW)
Entity Type:Individual
Prefix:MS
First Name:CORRIE
Middle Name:ANNE
Last Name:O'TOOLE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:CORRIE
Other - Middle Name:ANNE
Other - Last Name:HUNTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:12842 VALLEY VIEW ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2515
Mailing Address - Country:US
Mailing Address - Phone:714-379-1449
Mailing Address - Fax:
Practice Address - Street 1:12842 VALLEY VIEW ST
Practice Address - Street 2:SUITE 102
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-2515
Practice Address - Country:US
Practice Address - Phone:714-379-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS123171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical