Provider Demographics
NPI:1417247107
Name:CARINO, CAROLYN HUTCHINGS (LMSW, ACSW, SPADA)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:HUTCHINGS
Last Name:CARINO
Suffix:
Gender:F
Credentials:LMSW, ACSW, SPADA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4519 CASCADE RD SE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3666
Mailing Address - Country:US
Mailing Address - Phone:616-949-6262
Mailing Address - Fax:616-425-2003
Practice Address - Street 1:4519 CASCADE RD SE
Practice Address - Street 2:SUITE 3
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3666
Practice Address - Country:US
Practice Address - Phone:616-949-6262
Practice Address - Fax:616-425-2003
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010344691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI881817049OtherNASW ACADEMY OF CERTIFIED SOCIAL WORKERS