Provider Demographics
NPI:1609024314
Name:PRIPUSICH, CAROL M (LISW/LCSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:PRIPUSICH
Suffix:
Gender:F
Credentials:LISW/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 SAGEBRUSH DR
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-8387
Mailing Address - Country:US
Mailing Address - Phone:505-259-0038
Mailing Address - Fax:
Practice Address - Street 1:1109 SAGEBRUSH DR
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-8387
Practice Address - Country:US
Practice Address - Phone:505-259-0038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490028111041C0700X
NMI-057651041C0700X
FLSW65561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical