Provider Demographics
NPI:1952320418
Name:HARVEY, CAROL A (MS)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:HARVEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 G ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-4262
Mailing Address - Country:US
Mailing Address - Phone:707-765-2635
Mailing Address - Fax:
Practice Address - Street 1:204 G ST
Practice Address - Street 2:SUITE 205
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-4262
Practice Address - Country:US
Practice Address - Phone:707-765-2635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27229106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist