Provider Demographics
NPI:1639253909
Name:CARRASCO, JANET (LCSW)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:CARRASCO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:IBARRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:6575 ELDERBERRY CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-1539
Mailing Address - Country:US
Mailing Address - Phone:562-472-8501
Mailing Address - Fax:
Practice Address - Street 1:219 N INDIAN HILL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711
Practice Address - Country:US
Practice Address - Phone:562-472-8501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00156074104100000X
CALCSW291811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical