Provider Demographics
NPI:1083777965
Name:CARUSO, RICHARD P (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:P
Last Name:CARUSO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7470 KENNEDY RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-5420
Mailing Address - Country:US
Mailing Address - Phone:707-544-1707
Mailing Address - Fax:
Practice Address - Street 1:7470 KENNEDY RD
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-5420
Practice Address - Country:US
Practice Address - Phone:707-544-1707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 4650103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL46501Medicare PIN
CAR26024Medicare UPIN