Provider Demographics
NPI:1184794679
Name:CARHART, BLAINE PAUL (LCSW)
Entity type:Individual
Prefix:MR
First Name:BLAINE
Middle Name:PAUL
Last Name:CARHART
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6064 E OAKBROOK ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-2227
Mailing Address - Country:US
Mailing Address - Phone:562-537-6744
Mailing Address - Fax:
Practice Address - Street 1:2600 REDONDO AVE FL 3
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2325
Practice Address - Country:US
Practice Address - Phone:562-256-2974
Practice Address - Fax:562-290-0074
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS222291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical