Provider Demographics
NPI:1063751543
Name:CARSON, TAMMY HINCH (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:HINCH
Last Name:CARSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5743 CORSA AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4027
Mailing Address - Country:US
Mailing Address - Phone:818-889-6300
Mailing Address - Fax:
Practice Address - Street 1:5743 CORSA AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4027
Practice Address - Country:US
Practice Address - Phone:818-889-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA269061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical