Provider Demographics
NPI:1982658829
Name:CARNEY, B. PAUL (PHD)
Entity Type:Individual
Prefix:
First Name:B.
Middle Name:PAUL
Last Name:CARNEY
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 1:421 BENJAMIN LN STE 202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4845
Mailing Address - Country:US
Mailing Address - Phone:502-690-8024
Mailing Address - Fax:
Practice Address - Street 1:421 BENJAMIN LN STE 202
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4845
Practice Address - Country:US
Practice Address - Phone:502-690-8024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0927103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3007602Medicare ID - Type Unspecified
KY611203585Medicare UPIN