Provider Demographics
NPI:1730792383
Name:CARROLL-AMERINE, ANNE ELIZABETH
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:ELIZABETH
Last Name:CARROLL-AMERINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 DE LA GARZA ST APT A
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-2579
Mailing Address - Country:US
Mailing Address - Phone:325-201-8521
Mailing Address - Fax:
Practice Address - Street 1:1112 DE LA GARZA ST APT A
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-2579
Practice Address - Country:US
Practice Address - Phone:325-201-8521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst