Provider Demographics
NPI:1457458903
Name:CARRILLO, ANA MARIA (PHD)
Entity Type:Individual
Prefix:
First Name:ANA MARIA
Middle Name:
Last Name:CARRILLO
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 1:23360 CHAGRIN BOULEVARD, SUITE 205
Mailing Address - Street 2:SUITE 18
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-3199
Mailing Address - Country:US
Mailing Address - Phone:216-577-7551
Mailing Address - Fax:216-991-1020
Practice Address - Street 1:23360 CHAGRIN BLVD STE 205
Practice Address - Street 2:SUITE 18
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5537
Practice Address - Country:US
Practice Address - Phone:216-577-7551
Practice Address - Fax:216-991-1020
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3894103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist