Provider Demographics
NPI:1477522258
Name:KAIMANN, CARMEN RITA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:RITA
Last Name:KAIMANN
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 1:10882 FM 421 RD
Mailing Address - Street 2:
Mailing Address - City:KOUNTZE
Mailing Address - State:TX
Mailing Address - Zip Code:77625-6238
Mailing Address - Country:US
Mailing Address - Phone:409-899-3244
Mailing Address - Fax:
Practice Address - Street 1:3560 DELAWARE ST
Practice Address - Street 2:SUITE 107
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3067
Practice Address - Country:US
Practice Address - Phone:409-899-3244
Practice Address - Fax:409-898-3153
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-2875103T00000X
TX22875103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173000OtherCOMPSYCH
TX032038401Medicaid
TX86978AOtherBLUE CROSS/BLUE SHIELD