Provider Demographics
NPI:1568771897
Name:CARUSILLO, MARIA ANTONELLA (MS)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ANTONELLA
Last Name:CARUSILLO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 E 2ND AVE UNIT 35
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33605-5210
Mailing Address - Country:US
Mailing Address - Phone:813-892-7422
Mailing Address - Fax:
Practice Address - Street 1:2001 E 2ND AVE UNIT 35
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605-5210
Practice Address - Country:US
Practice Address - Phone:813-892-7422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13789101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health