Provider Demographics
NPI:1578627071
Name:SODERBERG, CARNEY (PSYD)
Entity Type:Individual
Prefix:
First Name:CARNEY
Middle Name:
Last Name:SODERBERG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13625 RONALD W REAGAN BLVD BLDG 4
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2073
Mailing Address - Country:US
Mailing Address - Phone:512-766-7803
Mailing Address - Fax:512-666-3768
Practice Address - Street 1:13625 RONALD W REAGAN BLVD BLDG 4
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2073
Practice Address - Country:US
Practice Address - Phone:512-766-7803
Practice Address - Fax:512-666-3768
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34565103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent