Healthcare Provider Details

I. General information

NPI: 1063654713
Provider Name (Legal Business Name): CAROL SHERTZER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 L ST
BAKERSFIELD CA
93301-4522
US

IV. Provider business mailing address

PO BOX 1000
BAKERSFIELD CA
93302-1000
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-5000
  • Fax: 661-836-8834
Mailing address:
  • Phone: 661-868-6600
  • Fax: 661-868-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28545
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number70138
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: