MEDICARE: CATHRYN CARSON 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	21210	CA

General Provider Information

NPI Number	:	1932782927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHRYN CARSON LCSW

Provider Business Mailing Address
First Line	:	1541 CASTEC DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95864-3004
Country	:	US
Telephone Number	:	310-614-6871
Fax Number	:

Provider Business Practice Location Address
First Line	:	1541 CASTEC DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95864-3004
Country	:	US
Telephone Number	:	310-614-6871
Fax Number	:

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

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	04/28/2021

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