Provider Demographics
NPI:1578330288
Name:CARMONA, STACY MARIE
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:MARIE
Last Name:CARMONA
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 1:900 JORIE BLVD STE 11
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2268
Mailing Address - Country:US
Mailing Address - Phone:708-990-8221
Mailing Address - Fax:
Practice Address - Street 1:900 JORIE BLVD STE 11
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2268
Practice Address - Country:US
Practice Address - Phone:708-990-8221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty