Healthcare Provider Details

I. General information

NPI: 1689141012
Provider Name (Legal Business Name): CARRIE ELIZABETH GIARRUSSO CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 BEACH ST
WESTERLY RI
02891-2718
US

IV. Provider business mailing address

572 MAIN ST APT 3
EAST GREENWICH RI
02818-3671
US

V. Phone/Fax

Practice location:
  • Phone: 401-596-0969
  • Fax:
Mailing address:
  • Phone: 401-533-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number200727
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: