Provider Demographics
NPI:1770629594
Name:PRICE, CAROLYN J (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:J
Last Name:PRICE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18313 PAULSON ST SW STE A
Practice Address - Street 2:PMG SW WA ROCHESTER FAM MED
Practice Address - City:ROCHESTER
Practice Address - State:WA
Practice Address - Zip Code:98579-9262
Practice Address - Country:US
Practice Address - Phone:360-827-8400
Practice Address - Fax:360-273-7301
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW601648721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical