Provider Demographics
NPI:1720002223
Name:LEBENTAL, CAROLE ELAINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:ELAINE
Last Name:LEBENTAL
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 1:24050 MADISON ST
Mailing Address - Street 2:SUITE 100 Q
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6015
Mailing Address - Country:US
Mailing Address - Phone:310-517-7990
Mailing Address - Fax:310-377-2358
Practice Address - Street 1:24050 MADISON ST
Practice Address - Street 2:SUITE 100 Q
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6015
Practice Address - Country:US
Practice Address - Phone:310-517-7990
Practice Address - Fax:310-377-2358
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS32731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS3273OtherLICENSE