Provider Demographics
NPI:1699307470
Name:PADRNOS, CAROLINE MARY (MS, LADC)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:MARY
Last Name:PADRNOS
Suffix:
Gender:F
Credentials:MS, LADC
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:MARY
Other - Last Name:ISTAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LADC
Mailing Address - Street 1:1100 E 80TH ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-1426
Mailing Address - Country:US
Mailing Address - Phone:952-956-3145
Mailing Address - Fax:
Practice Address - Street 1:1100 E 80TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-1426
Practice Address - Country:US
Practice Address - Phone:952-956-3145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305051101YA0400X
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)