Provider Demographics
NPI:1639501877
Name:LAKE, CAROLYN PERROTTI (DNP, NP-C, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:PERROTTI
Last Name:LAKE
Suffix:
Gender:F
Credentials:DNP, NP-C, PMHNP-BC
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:MARIE
Other - Last Name:PERROTTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, NP-C
Mailing Address - Street 1:1424 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5437
Mailing Address - Country:US
Mailing Address - Phone:916-259-6648
Mailing Address - Fax:
Practice Address - Street 1:5120 J ST STE A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3840
Practice Address - Country:US
Practice Address - Phone:916-455-9566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.005412363LF0000X
CA95003836363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health