Provider Demographics
NPI:1962824136
Name:CARBONELL, MARLA ELIZABETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARLA
Middle Name:ELIZABETH
Last Name:CARBONELL
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21500 CALIFA ST UNIT 130
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-4955
Mailing Address - Country:US
Mailing Address - Phone:818-521-3453
Mailing Address - Fax:
Practice Address - Street 1:130 N BRAND BLVD STE 202
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2617
Practice Address - Country:US
Practice Address - Phone:818-399-0540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 101YM0800X
CA1109911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty