Active NPI
Charisse Marie Caruth-Iacono, LAADC
- Addiction (Substance Use Disorder) Counselor
- Los Angeles, CA
National Provider Identifier
1679946479
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- LCAS-21587
- Practice address
- 1625 Schrader Blvd
Los Angeles, CA 90028-6213 - Phone
- (213) 466-5042
- NPI assigned
- Nov 3, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | RALR8960418 | CA | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LCAS-21587 | NC | Primary |
Addresses
Primary practice location
1625 Schrader Blvd
Los Angeles, CA 90028-6213
Mailing address
1625 Schrader Blvd
Los Angeles, CA 90028-6213
Phone (213) 466-5042
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01536011 | Other | CA | MEDI-CAL |
Other names 1
- Miss Charisse Marie Caruth
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCAS-21587 | NC | MD | Addiction (Substance Use Disorder) Counselor |
| RALR8960418 | CA | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1446508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601424000000",
"number": "1679946479",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1625 SCHRADER BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900286213",
"telephone_number": "213-466-5042"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1625 SCHRADER BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900286213",
"telephone_number": "213-466-5042"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARUTH-IACONO",
"first_name": "CHARISSE",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "LAADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-11-03",
"last_updated": "2020-09-30",
"certification_date": "2020-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "CA",
"license": "RALR8960418",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "LCAS-21587",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDI-CAL",
"identifier": "01536011",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "CHARISSE",
"last_name": "CARUTH",
"middle_name": "MARIE",
"prefix": "MISS",
"credential": "LCAS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.