Provider Demographics
NPI:1629670005
Name:CARNOHAN, KATIE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:CARNOHAN
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 1:5675 RUFFIN RD STE 325
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1391
Mailing Address - Country:US
Mailing Address - Phone:858-467-9170
Mailing Address - Fax:
Practice Address - Street 1:5675 RUFFIN RD STE 325
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1391
Practice Address - Country:US
Practice Address - Phone:858-467-9170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW973471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical