Provider Demographics
NPI:1992052633
Name:ROTACH-BEARD, CARISE MARIE (MA, LAMFT)
Entity type:Individual
Prefix:
First Name:CARISE
Middle Name:MARIE
Last Name:ROTACH-BEARD
Suffix:
Gender:F
Credentials:MA, LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-2433
Mailing Address - Country:US
Mailing Address - Phone:651-983-9215
Mailing Address - Fax:
Practice Address - Street 1:100 W FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2433
Practice Address - Country:US
Practice Address - Phone:651-983-9215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2445106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist