Provider Demographics
NPI:1295071058
Name:PREHN DESPOTA, CARA N (LCSW)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:N
Last Name:PREHN DESPOTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:N
Other - Last Name:PREHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1510 FASHION ISLAND BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1587
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 90TH ST FL 3
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1879
Practice Address - Country:US
Practice Address - Phone:415-746-9675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-26
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS283741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical