Provider Demographics
NPI:1851605612
Name:CARNEY, COLLEEN MARY (MSN, RN, PMHNP)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:MARY
Last Name:CARNEY
Suffix:
Gender:F
Credentials:MSN, RN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1001 POTRERO AVE
Mailing Address - Street 2:BUILDING 100, ROOM 350
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3518
Mailing Address - Country:US
Mailing Address - Phone:415-206-8843
Mailing Address - Fax:415-206-8182
Practice Address - Street 1:1001 POTRERO AVE
Practice Address - Street 2:BUILDING 100, ROOM 350
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-8843
Practice Address - Fax:415-206-8182
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA378570163WN0300X, 163W00000X
CA20988363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WN0300XNursing Service ProvidersRegistered NurseNephrology
No163W00000XNursing Service ProvidersRegistered Nurse