Provider Demographics
NPI:1629093612
Name:HARNEY, CAROLYN M (MA, LLP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:HARNEY
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15508 BROOKFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3006
Mailing Address - Country:US
Mailing Address - Phone:313-515-0806
Mailing Address - Fax:
Practice Address - Street 1:670 GRISWOLD ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2675
Practice Address - Country:US
Practice Address - Phone:248-347-3470
Practice Address - Fax:248-347-2242
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006573103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist