Provider Demographics
NPI:1013943471
Name:CARUSO, GIOVANNINA M (MFT)
Entity Type:Individual
Prefix:
First Name:GIOVANNINA
Middle Name:M
Last Name:CARUSO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9910 ANDERSON RANCH RD
Mailing Address - Street 2:
Mailing Address - City:DESCANSO
Mailing Address - State:CA
Mailing Address - Zip Code:91916-9734
Mailing Address - Country:US
Mailing Address - Phone:619-659-1162
Mailing Address - Fax:619-659-8766
Practice Address - Street 1:615 E LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4617
Practice Address - Country:US
Practice Address - Phone:619-659-1611
Practice Address - Fax:619-659-8766
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34806106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist