Basic Information
| Provider Information | |||||||||
| NPI: | 1366992513 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARINO | ||||||||
| FirstName: | CARISSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 INDUSTRIAL RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891022685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024744104 | ||||||||
| FaxNumber: | 7024744108 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 INDUSTRIAL RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024744104 | ||||||||
| FaxNumber: | 7024744108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2016 | ||||||||
| LastUpdateDate: | 08/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 101YA0400X | 02119-1 | NV | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.