Healthcare Provider Details

I. General information

NPI: 1225156912
Provider Name (Legal Business Name): MARIA RENEE CARRON MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6614 CLAYTON RD #179
SAINT LOUIS MO
63117-1602
US

IV. Provider business mailing address

6614 CLAYTON RD #179
SAINT LOUIS MO
63117-1602
US

V. Phone/Fax

Practice location:
  • Phone: 314-960-0475
  • Fax: 314-726-6692
Mailing address:
  • Phone: 314-960-0475
  • Fax: 314-726-6692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: