Provider Demographics
NPI:1396280772
Name:CARMONA, ANAIS (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANAIS
Middle Name:
Last Name:CARMONA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANAIS
Other - Middle Name:
Other - Last Name:PENA CARMONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 SYCAMORE CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1220
Mailing Address - Country:US
Mailing Address - Phone:213-334-8955
Mailing Address - Fax:
Practice Address - Street 1:1900 SYCAMORE CANYON RD
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1220
Practice Address - Country:US
Practice Address - Phone:626-429-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA932731041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical