Provider Demographics
NPI:1265568323
Name:ESTRELLA, CARMELY (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:CARMELY
Middle Name:
Last Name:ESTRELLA
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5551
Mailing Address - Country:US
Mailing Address - Phone:310-578-5916
Mailing Address - Fax:310-454-6423
Practice Address - Street 1:3106 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5551
Practice Address - Country:US
Practice Address - Phone:310-578-5916
Practice Address - Fax:310-454-6423
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 70541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR37797Medicare UPIN
CASW7054BMedicare ID - Type UnspecifiedPROVIDER ID