Provider Demographics
NPI:1205958246
Name:PRUITT, CAROL (LCSW)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:PRUITT
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:PO BOX 4161
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95063-4161
Mailing Address - Country:US
Mailing Address - Phone:831-429-2288
Mailing Address - Fax:
Practice Address - Street 1:4113 SCOTTS VALLEY DR STE 104
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4547
Practice Address - Country:US
Practice Address - Phone:831-429-2288
Practice Address - Fax:831-461-9700
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical