Provider Demographics
NPI:1952195927
Name:PARK, CAREY (ASW)
Entity type:Individual
Prefix:
First Name:CAREY
Middle Name:
Last Name:PARK
Suffix:
Gender:
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4641 22ND ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-2018
Mailing Address - Country:US
Mailing Address - Phone:916-212-7086
Mailing Address - Fax:
Practice Address - Street 1:4641 22ND ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-2018
Practice Address - Country:US
Practice Address - Phone:916-212-7086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128841101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health