Provider Demographics
NPI:1629648829
Name:CREMONA, CAROLYN LOUISE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:LOUISE
Last Name:CREMONA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8019 EXMOOR DR # B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-8228
Mailing Address - Country:US
Mailing Address - Phone:512-785-3528
Mailing Address - Fax:
Practice Address - Street 1:8019 EXMOOR DR # B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-8228
Practice Address - Country:US
Practice Address - Phone:512-785-3528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX629951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical