Provider Demographics
NPI:1811677271
Name:CARCAMO, DANA
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:CARCAMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2143 COMMISSARY CIR
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1024
Mailing Address - Country:US
Mailing Address - Phone:410-305-9892
Mailing Address - Fax:
Practice Address - Street 1:8373 PINEY ORCHARD PKWY STE 200
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1531
Practice Address - Country:US
Practice Address - Phone:410-305-9892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14025101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health