Provider Demographics
NPI:1134144280
Name:CARUSO, JENNIFER (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:CARUSO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:SAMPSONIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:10 HARBOR ST
Mailing Address - Street 2:C/O JENNIFER CARUSO
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3390
Mailing Address - Country:US
Mailing Address - Phone:978-619-6770
Mailing Address - Fax:
Practice Address - Street 1:10 HARBOR ST
Practice Address - Street 2:C/O JENNIFER CARUSO
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3390
Practice Address - Country:US
Practice Address - Phone:978-619-6770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1139691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA113969Medicare UPIN