Provider Demographics
NPI:1902018567
Name:CARR, DANIEL BRUCE (LMFT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:BRUCE
Last Name:CARR
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 1ST AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1596
Mailing Address - Country:US
Mailing Address - Phone:619-685-8638
Mailing Address - Fax:619-685-0042
Practice Address - Street 1:2333 1ST AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1596
Practice Address - Country:US
Practice Address - Phone:619-685-8638
Practice Address - Fax:619-685-0042
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 31037106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist