Provider Demographics
NPI:1841489416
Name:CARRILLO, ADRIANA G (LCSW)
Entity type:Individual
Prefix:MISS
First Name:ADRIANA
Middle Name:G
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 E COLORADO BLVD STE 528
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2056
Mailing Address - Country:US
Mailing Address - Phone:310-308-5689
Mailing Address - Fax:
Practice Address - Street 1:595 E COLORADO BLVD STE 528
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2056
Practice Address - Country:US
Practice Address - Phone:310-308-5689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS276621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical