Provider Demographics
NPI:1538557459
Name:RICKETTS, CAROLYN BETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:BETH
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:ELIZABETH
Other - Last Name:FURMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20200 REDWOOD ROAD,
Mailing Address - Street 2:SUITE 16
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546
Mailing Address - Country:US
Mailing Address - Phone:408-887-4267
Mailing Address - Fax:
Practice Address - Street 1:20200 REDWOOD ROAD
Practice Address - Street 2:SUITE 16
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546
Practice Address - Country:US
Practice Address - Phone:408-887-4267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW647801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical