Provider Demographics
NPI:1144338708
Name:CESARINI, KARLIE LEAH (LICSW)
Entity type:Individual
Prefix:MRS
First Name:KARLIE
Middle Name:LEAH
Last Name:CESARINI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KARLIE
Other - Middle Name:LEAH
Other - Last Name:WILLENBROCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:1 NORTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720
Mailing Address - Country:US
Mailing Address - Phone:508-679-4333
Mailing Address - Fax:508-679-3833
Practice Address - Street 1:1 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720
Practice Address - Country:US
Practice Address - Phone:508-679-4333
Practice Address - Fax:508-679-3833
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11073104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA022729Medicare ID - Type Unspecified