MEDICARE: MARLA CARBONELL LICENSED CLINICAL SOCIAL WORKER, PC

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

General Provider Information

NPI Number	:	1467307926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARLA CARBONELL LICENSED CLINICAL SOCIAL WORKER, PC

Provider Business Mailing Address
First Line	:	21500 CALIFA ST UNIT 130
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-4955
Country	:	US
Telephone Number	:	310-595-4511
Fax Number	:

Provider Business Practice Location Address
First Line	:	21500 CALIFA ST UNIT 130
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-4955
Country	:	US
Telephone Number	:	310-595-4511
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	MARLA ELIZABETH CARBONELL
Credential	:	LCSW
Telephone Number	:	310-595-4511

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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