Provider Demographics
NPI:1588870422
Name:WAISMAN, CAROL JOAN (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:JOAN
Last Name:WAISMAN
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4500 VIA MARINA
Mailing Address - Street 2:220
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-7214
Mailing Address - Country:US
Mailing Address - Phone:310-305-8822
Mailing Address - Fax:310-822-1240
Practice Address - Street 1:4640 ADMIRALTY WAY
Practice Address - Street 2:318
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6621
Practice Address - Country:US
Practice Address - Phone:310-804-7798
Practice Address - Fax:310-822-1240
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS6290104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker