MEDICARE: DOMENICA CONNOLLY CAROZZA 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	118716	CA
2	1041C0700X	Clinical Social Worker	137972	CA

General Provider Information

NPI Number	:	1730969668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMENICA CONNOLLY CAROZZA LCSW

Provider Business Mailing Address
First Line	:	2250 SOQUEL AVE
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-1402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2250 SOQUEL AVE
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-1402
Country	:	US
Telephone Number	:	831-600-2801
Fax Number	:

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

Provider Enumeration Date	:	09/28/2023
Last Update Date	:	04/21/2026

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