Provider Demographics
NPI:1831115310
Name:CARUSO, SARA ROSE (LCSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ROSE
Last Name:CARUSO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 E ELM AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4438
Mailing Address - Country:US
Mailing Address - Phone:208-676-1100
Mailing Address - Fax:
Practice Address - Street 1:803 E ELM AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4438
Practice Address - Country:US
Practice Address - Phone:208-676-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW4071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1692791Medicare ID - Type Unspecified