Provider Demographics
NPI:1689766784
Name:CARUSI, CHRISTOPHER MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:CARUSI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 MITCHELL VALLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-6338
Mailing Address - Country:US
Mailing Address - Phone:276-783-7600
Mailing Address - Fax:276-783-1802
Practice Address - Street 1:434 MITCHELL VALLEY DRIVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-6338
Practice Address - Country:US
Practice Address - Phone:276-783-7600
Practice Address - Fax:276-783-1802
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003040103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010186111Medicaid
VA015148586Medicaid
VA11525677OtherCAQH
VA179557OtherANTHEM
VA1689766784OtherNPI
VAS47559Medicare UPIN
VA00W560S02Medicare PIN