Provider Demographics
NPI:1083006654
Name:BISHOP, CARISA
Entity Type:Individual
Prefix:
First Name:CARISA
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 ALBANY TPKE STE 1
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019-2563
Mailing Address - Country:US
Mailing Address - Phone:603-726-1240
Mailing Address - Fax:
Practice Address - Street 1:171 ALBANY TPKE STE 1
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2563
Practice Address - Country:US
Practice Address - Phone:603-726-1240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-19
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor