Basic Information
| Provider Information | |||||||||
| NPI: | 1225116361 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MYLES | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5950 CANTERBURY DR APT C116 | ||||||||
| Address2: | |||||||||
| City: | CULVER CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902306717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106417723 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 S MCDONNELL AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900405623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239814301 | ||||||||
| FaxNumber: | 3238816733 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 18587 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.