Provider Demographics
NPI:1023484979
Name:INCLEDON, CAREY SHERILYN
Entity type:Individual
Prefix:DR
First Name:CAREY
Middle Name:SHERILYN
Last Name:INCLEDON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHERILYN
Other - Middle Name:MARIE
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4533 MACARTHUR BLVD STE 5100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2059
Mailing Address - Country:US
Mailing Address - Phone:949-466-8686
Mailing Address - Fax:949-688-5577
Practice Address - Street 1:1101 DOVE ST STE 190
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2827
Practice Address - Country:US
Practice Address - Phone:949-630-0630
Practice Address - Fax:949-688-5577
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31538103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist