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General NPI Number Information
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NPI Number | 1003634841
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Entity Type | Individual
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Provider Name | LISA CARUSO
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Gender | Female
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 2000 W STATE ST
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City | COAL TOWNSHIP
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State | PA
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Zip | 17866-2807
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Country | US
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Telephone | 570-648-5752
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Fax |
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Provider Business Mailing Address
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Address Line | 28 N FRONT ST
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City | SUNBURY
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State | PA
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Zip | 17801-2120
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Country | US
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Telephone | 423-315-1415
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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