Provider Demographics
NPI:1235925116
Name:MATSIK, CARLY (CLC)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:MATSIK
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 S BARRINGTON AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4434
Mailing Address - Country:US
Mailing Address - Phone:424-316-6787
Mailing Address - Fax:
Practice Address - Street 1:605 S BARRINGTON AVE APT 7
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-4434
Practice Address - Country:US
Practice Address - Phone:424-316-6787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAALPP-357606174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN