Healthcare Provider Details

I. General information

NPI: 1205904521
Provider Name (Legal Business Name): CARIN M MIZERA DSW LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W 2ND ST
DULUTH MN
55802-1928
US

IV. Provider business mailing address

205 W 2ND ST
DULUTH MN
55802-1928
US

V. Phone/Fax

Practice location:
  • Phone: 615-631-7543
  • Fax:
Mailing address:
  • Phone: 615-631-7543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number12677131
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6986123
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5075
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25089
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: