Provider Demographics
NPI:1659680510
Name:MACARUSO, IVELIS
Entity Type:Individual
Prefix:MRS
First Name:IVELIS
Middle Name:
Last Name:MACARUSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 MAIN ST
Mailing Address - Street 2:SUITE 560
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1893
Mailing Address - Country:US
Mailing Address - Phone:508-890-6519
Mailing Address - Fax:508-363-0562
Practice Address - Street 1:484 MAIN ST
Practice Address - Street 2:SUITE 560
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1893
Practice Address - Country:US
Practice Address - Phone:508-890-6519
Practice Address - Fax:508-363-0562
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health