Provider Demographics
NPI:1679820104
Name:CARMEN, AMY REBECCA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:REBECCA
Last Name:CARMEN
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 1:200 SHARPE ST
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-6030
Mailing Address - Country:US
Mailing Address - Phone:919-929-8824
Mailing Address - Fax:
Practice Address - Street 1:200 SHARPE ST
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-6030
Practice Address - Country:US
Practice Address - Phone:919-929-8824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0068961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical