Healthcare Provider Details

I. General information

NPI: 1477815801
Provider Name (Legal Business Name): CARRIE ELIZABETH ALLEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE ELIZABETH MCCABE LCSW

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E LATHAM AVE #A
HEMET CA
92543-4435
US

IV. Provider business mailing address

41133 SUNSET LN
HEMET CA
92544-7438
US

V. Phone/Fax

Practice location:
  • Phone: 951-652-8107
  • Fax:
Mailing address:
  • Phone: 951-663-6254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS22382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: