Provider Demographics
NPI:1760948798
Name:WHITLOW, DYLAN KIERAN (LCSW)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:KIERAN
Last Name:WHITLOW
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 1:3913 OAK VILLA CIR
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2161
Mailing Address - Country:US
Mailing Address - Phone:916-213-5733
Mailing Address - Fax:
Practice Address - Street 1:10621 SCHIRRA AVE
Practice Address - Street 2:
Practice Address - City:MATHER
Practice Address - State:CA
Practice Address - Zip Code:95655-4121
Practice Address - Country:US
Practice Address - Phone:916-213-5733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174H00000X174H00000X
CA1093661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17690948798OtherLICENSED CLINICAL SOCIAL WORKER
CA174H00000XOtherHEALTH EDUCATOR