Provider Demographics
NPI:1790748531
Name:CARNES, JOHN W (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:CARNES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8844
Mailing Address - Country:US
Mailing Address - Phone:813-885-7766
Mailing Address - Fax:813-889-0167
Practice Address - Street 1:2201 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8844
Practice Address - Country:US
Practice Address - Phone:727-871-1535
Practice Address - Fax:727-824-7133
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3562103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL205047100Medicaid
FL205047100Medicaid
FL75702ZMedicare ID - Type Unspecified