Individual
MISS CAROLYN ANNE MOTTOLA
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1020 S ANAHEIM BLVD, SUITE 215, ANAHEIM, CA 92708
(714) 237-4440
(714) 839-7460
Mailing address
PO BOX 8342, HUNTINGTON BEACH, CA 92615-8342
(714) 237-4440
(714) 839-7460
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY10163
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
077554
MANAGED HEALTH NETWORK
CA
01
—
4124629
AETNA
CA
01
—
OPL101631
BLUE SHIELD
CA
Enumeration date
11/08/2005
Last updated
07/08/2007
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