Provider Demographics
NPI:1730858838
Name:CARRANZA, ANGELICA MARIA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANGELICA
Middle Name:MARIA
Last Name:CARRANZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:MARIA
Other - Last Name:CARRANZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:4229 GREEN KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CA
Mailing Address - Zip Code:95368-9701
Mailing Address - Country:US
Mailing Address - Phone:209-613-2722
Mailing Address - Fax:
Practice Address - Street 1:600 B ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:CA
Practice Address - Zip Code:95334-9593
Practice Address - Country:US
Practice Address - Phone:209-850-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1038171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical