Provider Demographics
NPI:1366585531
Name:SORISHO, CARMEN HELENA (MA)
Entity type:Individual
Prefix:MISS
First Name:CARMEN
Middle Name:HELENA
Last Name:SORISHO
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:PO BOX 2087
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-0087
Mailing Address - Country:US
Mailing Address - Phone:209-385-3000
Mailing Address - Fax:209-354-2513
Practice Address - Street 1:2115 WARDROBE AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95341-6445
Practice Address - Country:US
Practice Address - Phone:209-385-3000
Practice Address - Fax:209-354-2513
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 57273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health