Provider Demographics
NPI:1396422507
Name:PONTING, CARISSA PAULINE (LCSW)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:PAULINE
Last Name:PONTING
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 1:811 JOHN ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1956
Mailing Address - Country:US
Mailing Address - Phone:971-344-2937
Mailing Address - Fax:
Practice Address - Street 1:811 JOHN ADAMS ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1956
Practice Address - Country:US
Practice Address - Phone:971-344-2937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA135831041C0700X
ORL300391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical