Provider Demographics
NPI:1619362712
Name:CARUSO, KIMBERLY (LISW-S)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CARUSO
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:WESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW-S
Mailing Address - Street 1:32 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:STRUTHERS
Mailing Address - State:OH
Mailing Address - Zip Code:44471-1917
Mailing Address - Country:US
Mailing Address - Phone:330-507-4652
Mailing Address - Fax:
Practice Address - Street 1:32 MOORE ST
Practice Address - Street 2:
Practice Address - City:STRUTHERS
Practice Address - State:OH
Practice Address - Zip Code:44471-1917
Practice Address - Country:US
Practice Address - Phone:330-507-4652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 15001891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical