Individual
MR. JONATHAN CAROLLO
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
3919 N MAPLE ST, SPOKANE, WA 99205-1349
(509) 444-8888
(509) 444-7806
Mailing address
1223 S CEDAR ST, SPOKANE, WA 99204-4029
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LW00006312
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8931692
L&I CRIME VIC
WA
Enumeration date
05/02/2006
Last updated
07/08/2007
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