Healthcare Provider Details

I. General information

NPI: 1194058495
Provider Name (Legal Business Name): DENISE CARRILLO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 BLANCO CIR STE B
SALINAS CA
93901-4451
US

IV. Provider business mailing address

951 BLANCO CIR STE B
SALINAS CA
93901-4451
US

V. Phone/Fax

Practice location:
  • Phone: 831-784-2150
  • Fax: 831-772-8154
Mailing address:
  • Phone: 831-784-2150
  • Fax: 831-772-8154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number77731
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: