MEDICARE: KATIE CARNOHAN LCSW

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	1041C0700X	Clinical Social Worker	LCSW97347	CA

General Provider Information

NPI Number	:	1629670005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE CARNOHAN LCSW

Provider Business Mailing Address
First Line	:	1930 S COAST HWY STE 100
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6466
Country	:	US
Telephone Number	:	619-796-2076
Fax Number	:

Provider Business Practice Location Address
First Line	:	1930 S COAST HWY STE 100
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6466
Country	:	US
Telephone Number	:	619-796-2076
Fax Number	:

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

Provider Enumeration Date	:	11/11/2020
Last Update Date	:	09/03/2024

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Directions to “ KATIE CARNOHAN LCSW” Practice Location

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