Provider Demographics
NPI:1245744507
Name:JUDITH CARNEY PSYD LLC
Entity Type:Organization
Organization Name:JUDITH CARNEY PSYD LLC
Other - Org Name:JUDITH CARNEY PSYD LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:HELENE
Authorized Official - Last Name:CARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:561-577-2352
Mailing Address - Street 1:245 SW NORTH WAKEFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-5443
Mailing Address - Country:US
Mailing Address - Phone:561-577-2352
Mailing Address - Fax:
Practice Address - Street 1:245 SW NORTH WAKEFIELD CIR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-5443
Practice Address - Country:US
Practice Address - Phone:561-577-2352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-24
Last Update Date:2017-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9240103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty