Provider Demographics
NPI:1760195176
Name:COLMENERO, CAROL (LMSW, LASAC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:COLMENERO
Suffix:
Gender:F
Credentials:LMSW, LASAC
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:DERRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:853 W SHANNON ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-7203
Mailing Address - Country:US
Mailing Address - Phone:480-930-3803
Mailing Address - Fax:
Practice Address - Street 1:3033 S ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-2717
Practice Address - Country:US
Practice Address - Phone:480-930-3803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13113101YA0400X
AZ152771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)