Provider Demographics
NPI:1356350920
Name:CARONA, KEN MICHAEL (MS,LPC)
Entity type:Individual
Prefix:MR
First Name:KEN
Middle Name:MICHAEL
Last Name:CARONA
Suffix:
Gender:M
Credentials:MS,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3747 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-5555
Mailing Address - Country:US
Mailing Address - Phone:409-983-7668
Mailing Address - Fax:
Practice Address - Street 1:3747 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-5555
Practice Address - Country:US
Practice Address - Phone:409-983-7668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17679101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional