Provider Demographics
NPI:1639108319
Name:KANEKO, CAROLYN LIBAO (LCSW)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:LIBAO
Last Name:KANEKO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:A
Other - Last Name:LIBAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:919 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-2957
Mailing Address - Country:US
Mailing Address - Phone:818-256-2242
Mailing Address - Fax:818-361-3217
Practice Address - Street 1:919 1ST ST
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-2957
Practice Address - Country:US
Practice Address - Phone:818-256-2242
Practice Address - Fax:818-361-3217
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 221971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical