Provider Demographics
NPI:1144301516
Name:LUTNESS, CAROLE LELAND (LCSW LAADC)
Entity type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:LELAND
Last Name:LUTNESS
Suffix:
Gender:F
Credentials:LCSW LAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25439 VIA MACARENA
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355
Mailing Address - Country:US
Mailing Address - Phone:661-755-7524
Mailing Address - Fax:661-799-3632
Practice Address - Street 1:23560 PEACHLAND AVE #204
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321
Practice Address - Country:US
Practice Address - Phone:661-755-7524
Practice Address - Fax:661-799-3632
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 187031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5895939Medicaid
CA5895939Medicaid