Provider Demographics
NPI:1508104787
Name:MANARO, CARISSA ANNE (LCSWA)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:ANNE
Last Name:MANARO
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:ANNE
Other - Last Name:STRUK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSWA
Mailing Address - Street 1:8390 SIX FORKS RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3060
Mailing Address - Country:US
Mailing Address - Phone:919-782-8730
Mailing Address - Fax:
Practice Address - Street 1:8390 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3060
Practice Address - Country:US
Practice Address - Phone:919-782-8730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0055451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical