Provider Demographics
NPI:1801007752
Name:CARRERA, CRISTINA I (MSW)
Entity type:Individual
Prefix:MS
First Name:CRISTINA
Middle Name:
Last Name:CARRERA
Suffix:I
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12907 LARIAT LN
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3315
Mailing Address - Country:US
Mailing Address - Phone:323-379-6887
Mailing Address - Fax:562-444-7057
Practice Address - Street 1:5150 CANDLEWOOD ST STE 4A
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1925
Practice Address - Country:US
Practice Address - Phone:323-379-6887
Practice Address - Fax:562-444-7057
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 250531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical