Provider Demographics
NPI:1679924559
Name:PRADO, CARRIE J (MSW)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:J
Last Name:PRADO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:STAHLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PETERSEN
Mailing Address - Street 1:PO BOX 1035
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-1035
Mailing Address - Country:US
Mailing Address - Phone:307-675-1805
Mailing Address - Fax:307-675-1809
Practice Address - Street 1:909 LONG DR STE A
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3282
Practice Address - Country:US
Practice Address - Phone:307-675-1805
Practice Address - Fax:307-675-1805
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
WY12471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator