Provider Demographics
NPI:1619009818
Name:WILLNER, CAROL SIEGAL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:SIEGAL
Last Name:WILLNER
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 1:10436 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 3010
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:310-281-6045
Mailing Address - Fax:
Practice Address - Street 1:10436 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 3010
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-281-6045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5997103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical