Healthcare Provider Details

I. General information

NPI: 1871411553
Provider Name (Legal Business Name): CARLY ROSE TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 582
WILLITS CA
95490-0582
US

IV. Provider business mailing address

PO BOX 582
WILLITS CA
95490-0582
US

V. Phone/Fax

Practice location:
  • Phone: 707-354-0437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number139447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: