Healthcare Provider Details

I. General information

NPI: 1174365571
Provider Name (Legal Business Name): CARISSA PAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 S FARRELL DR STE C208
PALM SPRINGS CA
92262-7944
US

IV. Provider business mailing address

490 S FARRELL DR STE C208
PALM SPRINGS CA
92262-7944
US

V. Phone/Fax

Practice location:
  • Phone: 760-325-4088
  • Fax: 760-778-3781
Mailing address:
  • Phone: 760-325-4088
  • Fax: 760-778-3781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: