Healthcare Provider Details

I. General information

NPI: 1477249639
Provider Name (Legal Business Name): CARLY CULOTTA COWDEN ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W VISTA WAY STE 407
VISTA CA
92083-5714
US

IV. Provider business mailing address

550 W VISTA WAY STE 407
VISTA CA
92083-5714
US

V. Phone/Fax

Practice location:
  • Phone: 760-758-1092
  • Fax: 760-560-2098
Mailing address:
  • Phone: 760-758-1092
  • Fax: 760-560-2098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number133721
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: