Provider Demographics
NPI:1851650170
Name:CAVALIER BOWDOIN, CARLA A (LCSW)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:A
Last Name:CAVALIER BOWDOIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 SILVER SPUR RD STE 105
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3663
Mailing Address - Country:US
Mailing Address - Phone:213-247-0577
Mailing Address - Fax:323-294-3127
Practice Address - Street 1:734 SILVER SPUR RD STE 105
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3663
Practice Address - Country:US
Practice Address - Phone:213-247-0577
Practice Address - Fax:323-294-3127
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical