Provider Demographics
NPI:1649869116
Name:MAKIE-BENNETT, CARLY DANA (LCSW)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:DANA
Last Name:MAKIE-BENNETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:MAKIE-BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:80 N WOOD RD STE 306
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-8312
Mailing Address - Country:US
Mailing Address - Phone:805-244-6919
Mailing Address - Fax:
Practice Address - Street 1:80 N WOOD RD STE 306
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-8312
Practice Address - Country:US
Practice Address - Phone:805-244-6919
Practice Address - Fax:805-941-0206
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA759191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical