Provider Demographics
NPI:1760856751
Name:CARUSO, JENNIFER S
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:CARUSO
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 1:350 S SCHMALE RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2794
Mailing Address - Country:US
Mailing Address - Phone:630-791-0118
Mailing Address - Fax:630-708-7654
Practice Address - Street 1:350 S SCHMALE RD
Practice Address - Street 2:SUITE 180
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2794
Practice Address - Country:US
Practice Address - Phone:630-791-0118
Practice Address - Fax:630-708-7654
Is Sole Proprietor?:No
Enumeration Date:2015-11-14
Last Update Date:2015-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health