Provider Demographics
NPI:1053400564
Name:CARUANA, DOUGLAS W (PSYD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:W
Last Name:CARUANA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9111 BROADWAY
Mailing Address - Street 2:SUITE Q
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410
Mailing Address - Country:US
Mailing Address - Phone:219-736-0003
Mailing Address - Fax:219-756-2315
Practice Address - Street 1:9111 BROADWAY
Practice Address - Street 2:SUITE Q
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410
Practice Address - Country:US
Practice Address - Phone:219-736-0003
Practice Address - Fax:219-756-2315
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040106A103TC0700X
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000176448OtherANTHEM
182370BMedicare ID - Type Unspecified