Provider Demographics
NPI:1871064188
Name:CARMONA, ANA M (PHD)
Entity type:Individual
Prefix:DR
First Name:ANA
Middle Name:M
Last Name:CARMONA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 HAYNES ST STE 3
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4548
Mailing Address - Country:US
Mailing Address - Phone:931-378-6612
Mailing Address - Fax:
Practice Address - Street 1:1821 HAYNES ST STE 3
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4548
Practice Address - Country:US
Practice Address - Phone:931-378-6612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-12
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3338103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist