Provider Demographics
NPI:1609496298
Name:RISBRUDT, CAROLYN (MA)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:RISBRUDT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 SYCAMORE RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4313
Mailing Address - Country:US
Mailing Address - Phone:805-464-7179
Mailing Address - Fax:
Practice Address - Street 1:5855 CAPISTRANO AVE STE G
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-7201
Practice Address - Country:US
Practice Address - Phone:805-464-7179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA135058106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist