Provider Demographics
NPI:1285895185
Name:CARREON, TAMMY ANNETTE (LMSW)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:ANNETTE
Last Name:CARREON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 MORNING STAR DR
Mailing Address - Street 2:UNIT 708
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-1677
Mailing Address - Country:US
Mailing Address - Phone:575-932-9136
Mailing Address - Fax:
Practice Address - Street 1:3650 MORNING STAR DR
Practice Address - Street 2:UNIT 708
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-1677
Practice Address - Country:US
Practice Address - Phone:575-932-9136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-06733104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker