Provider Demographics
NPI:1629248976
Name:CARASSO, JANINE MIRA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JANINE
Middle Name:MIRA
Last Name:CARASSO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 KIT CARSON ROAD, UNIT #5
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571
Mailing Address - Country:US
Mailing Address - Phone:575-779-7805
Mailing Address - Fax:
Practice Address - Street 1:1337 GUSDORF ROAD, SUITES E & F
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:575-758-4297
Practice Address - Fax:575-751-7237
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM065811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical