Provider Demographics
NPI:1306598198
Name:MORAN, CARMEN
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:
Last Name:MORAN
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:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-0129
Mailing Address - Country:US
Mailing Address - Phone:623-250-5239
Mailing Address - Fax:623-439-7349
Practice Address - Street 1:11225 N 28TH DR STE C206
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-5600
Practice Address - Country:US
Practice Address - Phone:623-250-5239
Practice Address - Fax:623-439-7349
Is Sole Proprietor?:No
Enumeration Date:2022-01-22
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician