Provider Demographics
NPI:1225156912
Name:CARRON, MARIA RENEE (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:RENEE
Last Name:CARRON
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6614 CLAYTON RD
Mailing Address - Street 2:#179
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1602
Mailing Address - Country:US
Mailing Address - Phone:314-960-0475
Mailing Address - Fax:314-726-6692
Practice Address - Street 1:6614 CLAYTON RD
Practice Address - Street 2:#179
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1602
Practice Address - Country:US
Practice Address - Phone:314-960-0475
Practice Address - Fax:314-726-6692
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities