Provider Demographics
NPI:1205348885
Name:CARMONA, CRISTINA
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:CARMONA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9121 SUNRISE LAKES BLVD APT 219
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-1360
Mailing Address - Country:US
Mailing Address - Phone:754-422-1124
Mailing Address - Fax:
Practice Address - Street 1:9155 NW 57TH ST APT 409
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33351-4391
Practice Address - Country:US
Practice Address - Phone:754-422-1124
Practice Address - Fax:754-422-1124
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003694103K00000X
NJ15BC00094500103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst