Provider Demographics
NPI:1679764559
Name:CARRASCO, KARIISA ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:KARIISA
Middle Name:ANNE
Last Name:CARRASCO
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 1:40 E MINARETS AVE
Mailing Address - Street 2:
Mailing Address - City:PINEDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93650-1239
Mailing Address - Country:US
Mailing Address - Phone:559-436-0482
Mailing Address - Fax:
Practice Address - Street 1:2445 W WHITES BRIDGE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-1225
Practice Address - Country:US
Practice Address - Phone:559-264-5096
Practice Address - Fax:559-223-2898
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA352041041C0700X
CA808241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00007301Medicaid