Provider Demographics
NPI:1326562927
Name:CARLOS, LUSERITO (BASW, MSW,)
Entity Type:Individual
Prefix:
First Name:LUSERITO
Middle Name:
Last Name:CARLOS
Suffix:
Gender:F
Credentials:BASW, MSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 LITTLE ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-1031
Mailing Address - Country:US
Mailing Address - Phone:408-294-2100
Mailing Address - Fax:
Practice Address - Street 1:2011 LITTLE ORCHARD ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-1031
Practice Address - Country:US
Practice Address - Phone:408-294-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor