Provider Demographics
NPI:1649967027
Name:CORMACK, CAROLINA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:CORMACK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:CAROLINA
Other - Middle Name:
Other - Last Name:CORMACK ORELLANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:9923 POTTER ST
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-3222
Mailing Address - Country:US
Mailing Address - Phone:562-533-1071
Mailing Address - Fax:
Practice Address - Street 1:9923 POTTER ST
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-3222
Practice Address - Country:US
Practice Address - Phone:562-533-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1303041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical