Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003268038 |
---|---|
Provider Name | Sherri Caruso |
First Address | Los Angeles, CA 90068-3649 |
Second Address | Los Angeles, CA 90034-3712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2016 |
Last Update Date | 29/01/2019 |