Provider Demographics
NPI:1235367137
Name:CARRASCA, CRESSON B (LICSW)
Entity Type:Individual
Prefix:
First Name:CRESSON
Middle Name:B
Last Name:CARRASCA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4004
Mailing Address - Country:US
Mailing Address - Phone:401-729-0080
Mailing Address - Fax:401-739-0438
Practice Address - Street 1:36 EAST AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4004
Practice Address - Country:US
Practice Address - Phone:401-729-0080
Practice Address - Fax:401-739-0438
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW012521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical