Provider Demographics
NPI:1518151646
Name:CARUSO, LISA A (CSW-R)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:CARUSO
Suffix:
Gender:F
Credentials:CSW-R
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CSW-R
Mailing Address - Street 1:300 TULIP ST
Mailing Address - Street 2:ROOM 20
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4965
Mailing Address - Country:US
Mailing Address - Phone:315-447-1235
Mailing Address - Fax:
Practice Address - Street 1:105 WOODSIDE LN
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-2525
Practice Address - Country:US
Practice Address - Phone:315-622-4198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR05458211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical