Provider Demographics
NPI:1124225867
Name:CARUSO, MARY ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:CARUSO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 E WEST HWY
Mailing Address - Street 2:SUITE 409
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4522
Mailing Address - Country:US
Mailing Address - Phone:301-656-9595
Mailing Address - Fax:
Practice Address - Street 1:4405 E WEST HWY
Practice Address - Street 2:SUITE 409
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4522
Practice Address - Country:US
Practice Address - Phone:301-656-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01488103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD76275Medicare ID - Type Unspecified