Provider Demographics
NPI:1003483900
Name:NOACK, CAROLYN GENEVIEVE (LCSW)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:GENEVIEVE
Last Name:NOACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6922 ENDERS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-2803
Mailing Address - Country:US
Mailing Address - Phone:858-692-6852
Mailing Address - Fax:
Practice Address - Street 1:8950 VILLA LA JOLLA DR STE C126
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1707
Practice Address - Country:US
Practice Address - Phone:858-221-7479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1016051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101605OtherCALIFORNIA BOARD OF BEHAVIORAL SCIENCES