Provider Demographics
NPI:1952421513
Name:SARAGOSSI, CAROL REGENE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:REGENE
Last Name:SARAGOSSI
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 1:17339 HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-2020
Mailing Address - Country:US
Mailing Address - Phone:818-885-1790
Mailing Address - Fax:818-885-0319
Practice Address - Street 1:6651 BALBOA BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-5529
Practice Address - Country:US
Practice Address - Phone:818-997-2640
Practice Address - Fax:818-996-9850
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 204151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS20415OtherLICENSED CLINICAL S.W.
CALCS20415OtherSCHOOL SOCIAL WORKER