Healthcare Provider Details

I. General information

NPI: 1003483900
Provider Name (Legal Business Name): CAROLYN GENEVIEVE NOACK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6994 EL CAMINO REAL STE 205F
CARLSBAD CA
92009-4153
US

IV. Provider business mailing address

7003 ALICANTE RD
CARLSBAD CA
92009-6209
US

V. Phone/Fax

Practice location:
  • Phone: 858-692-6852
  • Fax:
Mailing address:
  • Phone: 858-692-6852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: