Healthcare Provider Details

I. General information

NPI: 1811535701
Provider Name (Legal Business Name): DANIEL JOHN CARR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 S BEACON ST
SAN PEDRO CA
90731-4324
US

IV. Provider business mailing address

1003 S BEACON ST
SAN PEDRO CA
90731-4324
US

V. Phone/Fax

Practice location:
  • Phone: 310-514-4940
  • Fax:
Mailing address:
  • Phone: 424-287-9965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW140744
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: