Provider Demographics
NPI:1366992513
Name:FARINO, CARISSA
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:FARINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 INDUSTRIAL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2685
Mailing Address - Country:US
Mailing Address - Phone:702-474-4104
Mailing Address - Fax:702-474-4108
Practice Address - Street 1:1800 INDUSTRIAL RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102
Practice Address - Country:US
Practice Address - Phone:702-474-4104
Practice Address - Fax:702-474-4108
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
NV02119-1101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner