Provider Demographics
NPI:1942410618
Name:TANAKA, CAREY ANN NAOMI (PHD)
Entity type:Individual
Prefix:
First Name:CAREY ANN
Middle Name:NAOMI
Last Name:TANAKA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 ALBION ST
Mailing Address - Street 2:B3
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-2317
Mailing Address - Country:US
Mailing Address - Phone:303-333-3229
Mailing Address - Fax:
Practice Address - Street 1:1825 YORK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1213
Practice Address - Country:US
Practice Address - Phone:303-393-0304
Practice Address - Fax:303-388-1172
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1393101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health