Provider Demographics
NPI:1053734673
Name:SALAZAR, CARLA CARRENO (LCSW)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:CARRENO
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:CARRENO
Other - Last Name:SALAZAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1719 COCHRAN ST APT F
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2172
Mailing Address - Country:US
Mailing Address - Phone:805-638-7858
Mailing Address - Fax:
Practice Address - Street 1:5720 RALSTON ST STE 100
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7845
Practice Address - Country:US
Practice Address - Phone:805-777-3531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW764281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical