Provider Demographics
NPI:1922201714
Name:ANDERSON, CAROLYN ANNE (PHD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 PARK BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1925
Mailing Address - Country:US
Mailing Address - Phone:650-330-0453
Mailing Address - Fax:650-326-4965
Practice Address - Street 1:2501 PARK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1925
Practice Address - Country:US
Practice Address - Phone:650-330-0453
Practice Address - Fax:650-326-4965
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14244103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical