Provider Demographics
NPI:1689259418
Name:CARNINE, BERKLEY ANN
Entity Type:Individual
Prefix:
First Name:BERKLEY
Middle Name:ANN
Last Name:CARNINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:892 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-3030
Mailing Address - Country:US
Mailing Address - Phone:541-505-6301
Mailing Address - Fax:
Practice Address - Street 1:341 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3275
Practice Address - Country:US
Practice Address - Phone:541-505-6301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health