Provider Demographics
NPI:1972893584
Name:CARRA, AMBER MARIE (LMFT117061)
Entity Type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:MARIE
Last Name:CARRA
Suffix:
Gender:F
Credentials:LMFT117061
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45562 STANRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-1820
Mailing Address - Country:US
Mailing Address - Phone:661-429-6553
Mailing Address - Fax:
Practice Address - Street 1:45562 STANRIDGE AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-1820
Practice Address - Country:US
Practice Address - Phone:661-434-1943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117061106H00000X
CA72698106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15066191OtherCAQH NUMBER