Healthcare Provider Details

I. General information

NPI: 1598988370
Provider Name (Legal Business Name): KAREN J. CARTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN JOHNSON CARTER LCSW

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19066 MAGNOLIA ST
HUNTINGTON BEACH CA
92646-2232
US

IV. Provider business mailing address

13428 MAXELLA AVE #607
MARINA DEL REY CA
90292-5620
US

V. Phone/Fax

Practice location:
  • Phone: 714-384-3870
  • Fax: 714-242-1783
Mailing address:
  • Phone: 310-628-7654
  • Fax: 310-827-0523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS #21631
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: