Provider Demographics
NPI:1205904521
Name:MIZERA, CARIN M (DSW LICSW)
Entity type:Individual
Prefix:MS
First Name:CARIN
Middle Name:M
Last Name:MIZERA
Suffix:
Gender:F
Credentials:DSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1928
Mailing Address - Country:US
Mailing Address - Phone:615-631-7543
Mailing Address - Fax:
Practice Address - Street 1:205 W 2ND ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1928
Practice Address - Country:US
Practice Address - Phone:615-631-7543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12677131101YA0400X
WI69861231041C0700X
TN50751041C0700X
MN250891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40957200Medicaid
WI40957200Medicaid