Provider Demographics
NPI:1659519452
Name:HODGSON, CARISSA R (LCSW)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:R
Last Name:HODGSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 CROSS COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-1970
Mailing Address - Country:US
Mailing Address - Phone:608-209-3519
Mailing Address - Fax:
Practice Address - Street 1:267 CROSS COUNTRY RD
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-1970
Practice Address - Country:US
Practice Address - Phone:608-209-3519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI127312-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical