Provider Demographics
NPI:1679753578
Name:MARK P. CARNEY PSY.D. INC
Entity Type:Organization
Organization Name:MARK P. CARNEY PSY.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:CARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:302-425-4417
Mailing Address - Street 1:1601 CONCORD PIKE
Mailing Address - Street 2:SUITE#50
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3612
Mailing Address - Country:US
Mailing Address - Phone:302-425-4417
Mailing Address - Fax:302-425-0194
Practice Address - Street 1:1601 CONCORD PIKE
Practice Address - Street 2:SUITE#50
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3612
Practice Address - Country:US
Practice Address - Phone:302-425-4417
Practice Address - Fax:302-425-0194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000662103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000040301Medicaid