Provider Demographics
NPI:1609817550
Name:SOLLITT, CAROLYN T (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:T
Last Name:SOLLITT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 E PACIFIC COAST HWY
Mailing Address - Street 2:STE 225
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4216
Mailing Address - Country:US
Mailing Address - Phone:562-244-1609
Mailing Address - Fax:
Practice Address - Street 1:6615 E PACIFIC COAST HWY
Practice Address - Street 2:STE 225
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4216
Practice Address - Country:US
Practice Address - Phone:562-244-1609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7555103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFN277AMedicare PIN