Provider Demographics
NPI:1255460853
Name:CARUSO, NICK RICHARD (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:NICK
Middle Name:RICHARD
Last Name:CARUSO
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 E LE MARCHE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-2503
Mailing Address - Country:US
Mailing Address - Phone:602-332-1996
Mailing Address - Fax:602-271-2963
Practice Address - Street 1:2920 N 34TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-5250
Practice Address - Country:US
Practice Address - Phone:602-764-0812
Practice Address - Fax:602-271-2963
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-00591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical