Provider Demographics
NPI:1336256916
Name:CARUSO, BEVERLY JEAN (LICENSED INDEPENDENT)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:JEAN
Last Name:CARUSO
Suffix:
Gender:F
Credentials:LICENSED INDEPENDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 INGLEWOOD AVE SOUTH
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4111
Mailing Address - Country:US
Mailing Address - Phone:952-920-6568
Mailing Address - Fax:952-920-5891
Practice Address - Street 1:2829 INGLEWOOD AVE S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-4111
Practice Address - Country:US
Practice Address - Phone:952-920-6568
Practice Address - Fax:952-920-5891
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00479103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN00469OtherLICENSE SOCIAL WORKER