Provider Demographics
NPI:1386941524
Name:CARSON, RENEE DIANE (MA)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:DIANE
Last Name:CARSON
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34556 N APPALOOSA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85144-4431
Mailing Address - Country:US
Mailing Address - Phone:480-793-2622
Mailing Address - Fax:
Practice Address - Street 1:34556 N APPALOOSA WAY
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85144-4431
Practice Address - Country:US
Practice Address - Phone:480-793-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-10-7382103K00000X
ILC62572485734103K00000X
AZBEH-001235103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst