Provider Demographics
NPI:1952412447
Name:SIRAGUSA, CLARISSA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CLARISSA
Middle Name:
Last Name:SIRAGUSA
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 1:402 E MOSES ST
Mailing Address - Street 2:SUITE #108
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-3331
Mailing Address - Country:US
Mailing Address - Phone:918-225-0030
Mailing Address - Fax:918-225-0540
Practice Address - Street 1:402 E MOSES ST
Practice Address - Street 2:SUITE #108
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-3331
Practice Address - Country:US
Practice Address - Phone:918-225-0030
Practice Address - Fax:918-225-0540
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK30051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical