Provider Demographics
NPI:1679786602
Name:CARRASCO, JANICE CORRINE
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:CORRINE
Last Name:CARRASCO
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 1:2015 CEDAR AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-4623
Mailing Address - Country:US
Mailing Address - Phone:562-726-1312
Mailing Address - Fax:
Practice Address - Street 1:2015 CEDAR AVE APT 5
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-4623
Practice Address - Country:US
Practice Address - Phone:562-726-1312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)