Basic Information
| Provider Information | |||||||||
| NPI: | 1568182616 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WROBBEL | ||||||||
| FirstName: | CARISSA | ||||||||
| MiddleName: | JOY | ||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1335 DUBLIN RD STE 100A | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432157007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145380353 | ||||||||
| FaxNumber: | 6144293219 | ||||||||
| Practice Location | |||||||||
| Address1: | 1335 DUBLIN RD STE 100A | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432157007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145380353 | ||||||||
| FaxNumber: | 6144293219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2022 | ||||||||
| LastUpdateDate: | 08/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | S.2207567 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.