1053443838 NPI number — MS. PAOLA BEATRIZ CARAKER LMFT

Table of content: MS. PAOLA BEATRIZ CARAKER LMFT (NPI 1053443838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053443838 NPI number — MS. PAOLA BEATRIZ CARAKER LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARAKER
Provider First Name:
PAOLA
Provider Middle Name:
BEATRIZ
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KERNEUR
Provider Other First Name:
PAOLA
Provider Other Middle Name:
BEATRIZ
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFT INTERN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053443838
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
449 N. MAINE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-304-8557
Provider Business Mailing Address Fax Number:
844-965-9225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6777 N. WILLOW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-304-8557
Provider Business Practice Location Address Fax Number:
844-965-9225
Provider Enumeration Date:
03/09/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  IMF 42877 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: MFC45183 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: IMF 42877 . This is a "BBS LICENSE #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".