Provider Demographics
NPI:1962623504
Name:HENESY, CARMEN MARIE (RN)
Entity type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:MARIE
Last Name:HENESY
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:67 CANTERBURY AVENUE
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4435
Mailing Address - Country:US
Mailing Address - Phone:650-878-4272
Mailing Address - Fax:650-878-4932
Practice Address - Street 1:CHILD & ADOLESCENT SUPPORT ADVOCACY & RESOURCE CENTER
Practice Address - Street 2:995 POTRERO, RM 239
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110
Practice Address - Country:US
Practice Address - Phone:415-206-8386
Practice Address - Fax:415-206-6273
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA249795163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent