Provider Demographics
NPI:1477535250
Name:CARBARY, TIMOTHY J (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:CARBARY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 REGENCY CIR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2348
Mailing Address - Country:US
Mailing Address - Phone:859-373-0133
Mailing Address - Fax:859-373-8119
Practice Address - Street 1:261 REGENCY CIR
Practice Address - Street 2:SUITE 4
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2348
Practice Address - Country:US
Practice Address - Phone:859-373-0133
Practice Address - Fax:859-373-8119
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1308103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0746801Medicare ID - Type Unspecified
KYP77917Medicare UPIN