Healthcare Provider Details

I. General information

NPI: 1669919882
Provider Name (Legal Business Name): CAROL SIDA ASW138035
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23504 LYONS AVE STE 401B
SANTA CLARITA CA
91321-5777
US

IV. Provider business mailing address

145 S GLENOAKS BLVD UNIT 3118
BURBANK CA
91502-1315
US

V. Phone/Fax

Practice location:
  • Phone: 661-977-4747
  • Fax: 661-999-3313
Mailing address:
  • Phone: 818-447-8536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW138035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: