Provider Demographics
NPI:1093369456
Name:CARUSO, STEPHANIE A
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:A
Last Name:CARUSO
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 1:18300 BLUEBELL LN
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-3108
Mailing Address - Country:US
Mailing Address - Phone:301-221-5909
Mailing Address - Fax:
Practice Address - Street 1:5416 16TH AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3444
Practice Address - Country:US
Practice Address - Phone:855-255-5270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-19-83044106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician