Provider Demographics
NPI:1790076099
Name:CARMONA, SUZANNE (PHD, CN)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:CARMONA
Suffix:
Gender:F
Credentials:PHD, CN
Other - Prefix:
Other - First Name:SAHNA
Other - Middle Name:
Other - Last Name:CARMONA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, CN
Mailing Address - Street 1:1122 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-2720
Mailing Address - Country:US
Mailing Address - Phone:303-772-5252
Mailing Address - Fax:
Practice Address - Street 1:1122 15TH AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2720
Practice Address - Country:US
Practice Address - Phone:303-443-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5658101YM0800X
133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education