Basic Information
| Provider Information | |||||||||
| NPI: | 1457917221 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARMONA | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 W BLUE HERON BLVD | ||||||||
| Address2: | |||||||||
| City: | RIVIERA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334045003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618413500 | ||||||||
| FaxNumber: | 5617271056 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 W BLUE HERON BLVD | ||||||||
| Address2: | |||||||||
| City: | RIVIERA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334045003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058469807 | ||||||||
| FaxNumber: | 3058469711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2019 | ||||||||
| LastUpdateDate: | 08/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.