Provider Demographics
NPI:1003662818
Name:DECERCE, CARLY ELIZABETH (RAD-T LEVEL I)
Entity type:Individual
Prefix:MISS
First Name:CARLY
Middle Name:ELIZABETH
Last Name:DECERCE
Suffix:
Gender:F
Credentials:RAD-T LEVEL I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-1326
Mailing Address - Country:US
Mailing Address - Phone:310-848-7132
Mailing Address - Fax:
Practice Address - Street 1:1002 PICO BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-1416
Practice Address - Country:US
Practice Address - Phone:310-848-7132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)