Provider Demographics
NPI:1700093523
Name:WARE-KAWAMOTO, CARRIE ALICIA (MS, MFT)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:ALICIA
Last Name:WARE-KAWAMOTO
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 BANCROFT AVE
Mailing Address - Street 2:SUITE 125C
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2403
Mailing Address - Country:US
Mailing Address - Phone:510-383-5001
Mailing Address - Fax:510-383-5117
Practice Address - Street 1:7200 BANCROFT AVE
Practice Address - Street 2:SUITE 125C
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2403
Practice Address - Country:US
Practice Address - Phone:510-383-5001
Practice Address - Fax:510-383-5117
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT31005106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist