Provider Demographics
NPI:1134382385
Name:GERARD, CAROLYN (MA, MFT)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:GERARD
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12625 HIGH BLUFF DR STE 316
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2054
Mailing Address - Country:US
Mailing Address - Phone:858-756-8171
Mailing Address - Fax:858-756-9595
Practice Address - Street 1:12625 HIGH BLUFF DR STE 316
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2054
Practice Address - Country:US
Practice Address - Phone:858-756-8171
Practice Address - Fax:858-756-9595
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 20719106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist