Healthcare Provider Details

I. General information

NPI: 1356675060
Provider Name (Legal Business Name): CARLEY K CANTWELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLEY WESTLING-SABA

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 5TH ST
BROOKINGS OR
97415-9702
US

IV. Provider business mailing address

500 5TH ST
BROOKINGS OR
97415-9702
US

V. Phone/Fax

Practice location:
  • Phone: 541-412-2000
  • Fax: 541-412-2081
Mailing address:
  • Phone: 541-412-2000
  • Fax: 541-412-2081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL7211
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: