Provider Demographics
NPI:1174626576
Name:JORGENSEN, CARLA JEAN (MSW)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:JEAN
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:CARLA
Other - Middle Name:JEAN
Other - Last Name:CRIDDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2805 NORTH G STREET
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340
Mailing Address - Country:US
Mailing Address - Phone:209-726-3171
Mailing Address - Fax:209-722-7029
Practice Address - Street 1:2805 G STREET
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340
Practice Address - Country:US
Practice Address - Phone:209-726-3171
Practice Address - Fax:209-722-7029
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 185731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical