1154417301 NPI number — ANNE CAROLYN CARNEY LCPC LCADC

Table of content: (NPI 1245387547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154417301 NPI number — ANNE CAROLYN CARNEY LCPC LCADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARNEY
Provider First Name:
ANNE
Provider Middle Name:
CAROLYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC LCADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154417301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10400 RIDGELAND ROAD
Provider Second Line Business Mailing Address:
STE 1
Provider Business Mailing Address City Name:
COCKEYSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-628-6120
Provider Business Mailing Address Fax Number:
410-628-9825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10400 RIDGELAND ROAD
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
COCKEYSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-628-6120
Provider Business Practice Location Address Fax Number:
410-628-9825
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  LCA251 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: LC1269 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 63679801 . This is a "CAREFIRST MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: R5830038 . This is a "CAREFIRST GHMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 233639 . This is a "COM PSYCH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 404247600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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