Healthcare Provider Details

I. General information

NPI: 1871712919
Provider Name (Legal Business Name): CAROLYN P. HIMMELGREEN M.S.D.T.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EDMONDS RD
REDWOOD CITY CA
94062-3813
US

IV. Provider business mailing address

245 BUSH ST #8
MOUNTAIN VIEW CA
94041-1300
US

V. Phone/Fax

Practice location:
  • Phone: 650-367-1890
  • Fax: 650-369-6465
Mailing address:
  • Phone: 650-965-4462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberDTR801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: