Provider Demographics
NPI:1871949339
Name:MEYLAN, CAROL LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNN
Last Name:MEYLAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 VIA DE LA PAZ
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-4362
Mailing Address - Country:US
Mailing Address - Phone:310-795-8249
Mailing Address - Fax:
Practice Address - Street 1:514 VIA DE LA PAZ
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-4362
Practice Address - Country:US
Practice Address - Phone:310-795-8249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA284221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical