Provider Demographics
NPI:1487275608
Name:CARRANCO, CLARISSA MARIE (MA)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:MARIE
Last Name:CARRANCO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 CHERRY CT
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-4143
Mailing Address - Country:US
Mailing Address - Phone:408-794-9666
Mailing Address - Fax:
Practice Address - Street 1:1441 CONSTITUTION BLVD BLDG 400
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3100
Practice Address - Country:US
Practice Address - Phone:831-796-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst