Provider Demographics
NPI:1740799667
Name:BARRAGAN, CARISSA LIANNA (YOUTH COUNSELOR)
Entity Type:Individual
Prefix:MS
First Name:CARISSA
Middle Name:LIANNA
Last Name:BARRAGAN
Suffix:
Gender:F
Credentials:YOUTH COUNSELOR
Other - Prefix:MS
Other - First Name:CARISSA
Other - Middle Name:LIANNA
Other - Last Name:BARRAGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CARI
Mailing Address - Street 1:499 LOMA ALTA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-6227
Mailing Address - Country:US
Mailing Address - Phone:408-364-4157
Mailing Address - Fax:
Practice Address - Street 1:499 LOMA ALTA AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-6227
Practice Address - Country:US
Practice Address - Phone:408-364-4157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor