Provider Demographics
NPI:1548931660
Name:CARLOS ESCAMILLA, AIDA DEL CARMEN (LCSW)
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:DEL CARMEN
Last Name:CARLOS ESCAMILLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AIDA
Other - Middle Name:
Other - Last Name:CARLOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:24552 RAYMOND WAY # 604
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-9000
Mailing Address - Country:US
Mailing Address - Phone:805-637-7805
Mailing Address - Fax:
Practice Address - Street 1:24552 RAYMOND WAY # 604
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-9000
Practice Address - Country:US
Practice Address - Phone:805-637-7805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1275151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical