Provider Demographics
NPI:1548618689
Name:CARUSO, MARISSA (MS ED SLP)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:CARUSO
Suffix:
Gender:F
Credentials:MS ED SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:BLASDELL
Mailing Address - State:NY
Mailing Address - Zip Code:14219-1625
Mailing Address - Country:US
Mailing Address - Phone:716-998-2697
Mailing Address - Fax:
Practice Address - Street 1:101 MILLER AVE
Practice Address - Street 2:
Practice Address - City:BLASDELL
Practice Address - State:NY
Practice Address - Zip Code:14219-1625
Practice Address - Country:US
Practice Address - Phone:716-998-2697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program