Provider Demographics
NPI:1992339501
Name:ARMENGOL, CARMEN G (PHD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:G
Last Name:ARMENGOL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:PROF
Other - First Name:CARMEN
Other - Middle Name:G
Other - Last Name:ARMENGOL DE LA MIYAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:280 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4414
Mailing Address - Country:US
Mailing Address - Phone:617-522-7061
Mailing Address - Fax:
Practice Address - Street 1:58 ROCHAMBEAU AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-1908
Practice Address - Country:US
Practice Address - Phone:617-524-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI472103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS81364143OtherDRIVER'S LICENSE