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General NPI Number Information
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NPI Number | 1578069001
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Entity Type | Individual
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Provider Name | CAROL-ANNE PUGLIESE
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Gender | Female
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 1 SAINT VINCENTS DR
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City | SAN RAFAEL
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State | CA
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Zip | 94903-1504
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Country | US
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Telephone | 415-507-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 73 ROUNDTREE BLVD
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City | SAN RAFAEL
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State | CA
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Zip | 94903-1633
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Country | US
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Telephone | 516-318-1663
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 96384
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 96384
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 114251
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License Number State | CA
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