MEDICARE: CAROLINE MARIE PAXSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	69107	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	69107	OTHER	CA	BOARD OF BEHAVIORAL SCIENCES

General Provider Information

NPI Number	:	1225447584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE MARIE PAXSON LCSW

Provider Business Mailing Address
First Line	:	418A HAIGHT AVE
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-3232
Country	:	US
Telephone Number	:	510-589-4291
Fax Number	:

Provider Business Practice Location Address
First Line	:	3873 HOWE ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-5343
Country	:	US
Telephone Number	:	510-922-0207
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2014
Last Update Date	:	02/06/2026

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