Provider Demographics
NPI:1629172820
Name:CARBERRY, ANN T (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:T
Last Name:CARBERRY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 CAREN DRIVE
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-8571
Mailing Address - Country:US
Mailing Address - Phone:410-549-9690
Mailing Address - Fax:
Practice Address - Street 1:815 CAREN DRIVE
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-8571
Practice Address - Country:US
Practice Address - Phone:410-549-9690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02109103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
003115OtherVALUE OPTIONS
MD243824OtherMAMSI
10415125OtherCAQH
MD521135-03OtherCAREFIRST BCBS
939039OtherFIRST HEALTH
DCB213-0001OtherDC BCBS/FEP
939039OtherFIRST HEALTH