Provider Demographics
NPI:1972176105
Name:CLEVELAND, CARRIE ANN (LMFT)
Entity Type:Individual
Prefix:
First Name:CARRIE ANN
Middle Name:
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CARRIE ANN
Other - Middle Name:
Other - Last Name:FABBROCINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:22258 CRISWELL ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2405
Mailing Address - Country:US
Mailing Address - Phone:310-883-5301
Mailing Address - Fax:
Practice Address - Street 1:22231 MULHOLLAND HWY
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-5123
Practice Address - Country:US
Practice Address - Phone:310-883-5301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-24
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126646106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist