=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770448060
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CONCEPCION CARRILLO ACSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2025
-----------------------------------------------------
Last Update Date | 12/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5300 SOQUEL AVE
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95062-7805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-576-1750
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1118
-----------------------------------------------------
City | FREEDOM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95019-1118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-373-6486
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | ASW134836
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------