Healthcare Provider Details

I. General information

NPI: 1679764559
Provider Name (Legal Business Name): KARIISA ANNE CARRASCO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 W WHITES BRIDGE AVE
FRESNO CA
93706-1225
US

IV. Provider business mailing address

40 E MINARETS AVE
PINEDALE CA
93650-1239
US

V. Phone/Fax

Practice location:
  • Phone: 559-264-5096
  • Fax: 559-223-2898
Mailing address:
  • Phone: 559-436-0482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number35204
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number80824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: