Provider Demographics
NPI:1215567912
Name:RANALDO, CAROL JOANNE (LMSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JOANNE
Last Name:RANALDO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 LA CANONITA WAY
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-5441
Mailing Address - Country:US
Mailing Address - Phone:928-515-3533
Mailing Address - Fax:
Practice Address - Street 1:610 LA CANONITA WAY
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-5441
Practice Address - Country:US
Practice Address - Phone:928-515-3533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-16330104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker