Provider Demographics
NPI:1184849515
Name:CARUSO, NORMA J
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:J
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 1:2803 MCRAE ROAD
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3000
Mailing Address - Country:US
Mailing Address - Phone:804-272-7287
Mailing Address - Fax:804-378-1514
Practice Address - Street 1:2803 MCRAE ROAD
Practice Address - Street 2:SUITE 3B
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-3000
Practice Address - Country:US
Practice Address - Phone:804-272-7287
Practice Address - Fax:804-378-1514
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002039103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7703074Medicaid
VA7703074Medicaid
VA680001402Medicare ID - Type Unspecified
R79473Medicare UPIN