MEDICARE: KIMBERLY CARUSO LISW-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	I 1500189	OH

General Provider Information

NPI Number	:	1619362712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY CARUSO LISW-S

Provider Business Mailing Address
First Line	:	32 MOORE ST
Second Line	:
City	:	STRUTHERS
State	:	OH
Zip	:	44471-1917
Country	:	US
Telephone Number	:	330-507-4652
Fax Number	:

Provider Business Practice Location Address
First Line	:	32 MOORE ST
Second Line	:
City	:	STRUTHERS
State	:	OH
Zip	:	44471-1917
Country	:	US
Telephone Number	:	330-507-4652
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2015
Last Update Date	:	12/20/2019

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Directions to “ KIMBERLY CARUSO LISW-S” Practice Location

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