Basic Information
Provider Information
NPI: 1003004250
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CARRUBBA
FirstName: JOANNE
MiddleName: FRANCES
NamePrefix:  
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11000 ANDERSON MILL RD UNIT 84
Address2:  
City: AUSTIN
State: TX
PostalCode: 787502410
CountryCode: US
TelephoneNumber: 5124875248
FaxNumber:  
Practice Location
Address1: 1433 FAIRFIELD DR
Address2:  
City: AUSTIN
State: TX
PostalCode: 787587244
CountryCode: US
TelephoneNumber: 5124918444
FaxNumber: 5124910226
Other Information
ProviderEnumerationDate: 10/11/2007
LastUpdateDate: 10/11/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X50961TXY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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