Provider Demographics
NPI:1154396224
Name:CARUSO, MARY J (MA, LMHC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:J
Last Name:CARUSO
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12128 N DIVISION ST # 219
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1905
Mailing Address - Country:US
Mailing Address - Phone:509-999-4473
Mailing Address - Fax:509-465-9803
Practice Address - Street 1:14206 N RIVILLA LN
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-8227
Practice Address - Country:US
Practice Address - Phone:509-999-4473
Practice Address - Fax:509-465-9803
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00008738101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health