Provider Demographics
NPI:1891296638
Name:CARNEY, MARY LOUISE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOUISE
Last Name:CARNEY
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 1:10939 ELLSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2136
Mailing Address - Country:US
Mailing Address - Phone:225-205-9900
Mailing Address - Fax:
Practice Address - Street 1:4521 JAMESTOWN AVE STE 2
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-3234
Practice Address - Country:US
Practice Address - Phone:225-227-2548
Practice Address - Fax:888-425-0972
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician