MEDICARE: MR. RICHARD PETER CARO II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPCC 248	CA
2	106H00000X	Marriage & Family Therapist	50497	CA
3	103TC0700X	Clinical Psychologist	32504	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3872	OTHER	CA	MENTAL HEALTH WORKER
2	MFT 50497	OTHER	CA	LICENSE
3	LPCC 248	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1205908878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD PETER CARO II

Provider Business Mailing Address
First Line	:	2716 7TH ST
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-4414
Country	:	US
Telephone Number	:	310-428-8488
Fax Number	:

Provider Business Practice Location Address
First Line	:	21445 CENTRE POINTE PKWY
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91350-2684
Country	:	US
Telephone Number	:	661-259-0033
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	05/14/2021

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