Provider Demographics
NPI:1083827851
Name:CARNEY, PATRICK STEPHEN (LP)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:STEPHEN
Last Name:CARNEY
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17711 SOUTHRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-2458
Mailing Address - Country:US
Mailing Address - Phone:952-288-7940
Mailing Address - Fax:
Practice Address - Street 1:860 BLUE GENTIAN RD STE 200
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1567
Practice Address - Country:US
Practice Address - Phone:651-252-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5073103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist