Provider Demographics
NPI:1457510372
Name:CARR, DENA NICOLE (LICENSED MFT)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:NICOLE
Last Name:CARR
Suffix:
Gender:F
Credentials:LICENSED MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 201
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-0201
Mailing Address - Country:US
Mailing Address - Phone:626-200-0792
Mailing Address - Fax:
Practice Address - Street 1:521 GREAT AMERICA PKWY
Practice Address - Street 2:SUITE 320
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1140
Practice Address - Country:US
Practice Address - Phone:626-200-0792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA171M00000X
CA130460106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7601AOtherHATHAWAY-SYCAMORE