Provider Demographics
NPI:1356177554
Name:ANTOSH, CAROL ANN (PHD,)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:ANTOSH
Suffix:
Gender:F
Credentials:PHD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18433
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92817-8433
Mailing Address - Country:US
Mailing Address - Phone:714-510-6682
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 18433
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92817-8433
Practice Address - Country:US
Practice Address - Phone:714-510-6682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT23424106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist