Healthcare Provider Details

I. General information

NPI: 1780156638
Provider Name (Legal Business Name): CHELSEA OLIVAR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA DE CARVALHO FONSECA

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W TOWN AND COUNTRY RD STE 1250
ORANGE CA
92868-4633
US

IV. Provider business mailing address

10408 CALLE CHULITA NW
ALBUQUERQUE NM
87114-5367
US

V. Phone/Fax

Practice location:
  • Phone: 714-543-5437
  • Fax:
Mailing address:
  • Phone: 714-323-4512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number84709
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: