Provider Demographics
NPI:1659914026
Name:MICHAEL F CARUSO ED D PSYCHOLOGIST
Entity Type:Organization
Organization Name:MICHAEL F CARUSO ED D PSYCHOLOGIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:ED D
Authorized Official - Phone:817-846-0632
Mailing Address - Street 1:1100 SCARLET CT
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-4107
Mailing Address - Country:US
Mailing Address - Phone:817-846-0632
Mailing Address - Fax:817-394-1409
Practice Address - Street 1:615 W HARWOOD RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3106
Practice Address - Country:US
Practice Address - Phone:817-449-0022
Practice Address - Fax:817-394-1402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22364OtherTEXAS PSYCHOLOGIST LICENSE NUMBER