Provider Demographics
NPI:1659605111
Name:NISHIMOTO, CAROLYN CATER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:CATER
Last Name:NISHIMOTO
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 1:2021 E 4TH ST STE 116
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3912
Mailing Address - Country:US
Mailing Address - Phone:714-541-5582
Mailing Address - Fax:714-541-2409
Practice Address - Street 1:2021 E 4TH ST STE 116
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3912
Practice Address - Country:US
Practice Address - Phone:714-541-5582
Practice Address - Fax:714-541-2409
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS142431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical