Provider Demographics
NPI:1144420423
Name:KOLAKAUSKAS, CARISSA KIMBERLY
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:KIMBERLY
Last Name:KOLAKAUSKAS
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 1:4309 ANNUNCIATION ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-1438
Mailing Address - Country:US
Mailing Address - Phone:504-715-3025
Mailing Address - Fax:
Practice Address - Street 1:3520 DRYADES ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-5331
Practice Address - Country:US
Practice Address - Phone:504-654-9294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPENDING1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical