Provider Demographics
NPI:1245340702
Name:NAGLE, CAROL (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:NAGLE
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:NAGLE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:2180 JEFFERSON ST
Mailing Address - Street 2:SUITE # 209
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-1250
Mailing Address - Country:US
Mailing Address - Phone:707-252-7811
Mailing Address - Fax:707-226-9026
Practice Address - Street 1:2180 JEFFERSON ST
Practice Address - Street 2:SUITE # 209
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-1250
Practice Address - Country:US
Practice Address - Phone:707-252-7811
Practice Address - Fax:707-226-9026
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS118351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ40309ZMedicare ID - Type Unspecified