Carissa Michelle Witham, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

115199 Issued in CA

Practice address

1041 E Yorba Linda Blvd
Placentia, CA 92870-3728

Phone

(800) 701-0937

NPI assigned

May 14, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Forward Wellness Family Therapy, Inc.

  • Community/Behavioral Health Agency
  • Placentia, CA
  • NPI 1093398059
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1526256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691020800000",
    "number": "1386134484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1041 E YORBA LINDA BLVD STE 202",
            "city": "PLACENTIA",
            "state": "CA",
            "postal_code": "928703760",
            "telephone_number": "800-701-0937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1041 E YORBA LINDA BLVD",
            "city": "PLACENTIA",
            "state": "CA",
            "postal_code": "928703728",
            "telephone_number": "800-701-0937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITHAM",
        "first_name": "CARISSA",
        "middle_name": "MICHELLE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-14",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "92842",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "115199",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7420",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6758",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7068",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristen R Wilson, MS, CCC-SLP
• Monica Symone Wilson
• Neiah Lee Wilson
• Stephanie Anna Wilson, SLPA
• Katherine M Wismer, LMFT
• Bethany Wong
• Jessalyn Lianne Garling Wong, D.O.
• Kin Cho Wong, DDS
• Michael Yuwei Wong, PHARMD
• Naomi Wong

• Clinical Social Worker in Placentia, CA
• Providers in Placentia, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.