Provider Demographics
NPI:1467454140
Name:CARUSO, VINCENT A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:A
Last Name:CARUSO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3632 HAWKSHEAD DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6940
Mailing Address - Country:US
Mailing Address - Phone:352-243-1319
Mailing Address - Fax:
Practice Address - Street 1:3632 HAWKSHEAD DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6940
Practice Address - Country:US
Practice Address - Phone:352-243-1319
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW13441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ5916Medicare ID - Type UnspecifiedPART 'B' PROVIDER