Provider Demographics
NPI:1013939032
Name:CARNEVALE, GEORGE JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JOSEPH
Last Name:CARNEVALE
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 1:2 GIRARD PL
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3108
Mailing Address - Country:US
Mailing Address - Phone:973-761-0692
Mailing Address - Fax:
Practice Address - Street 1:1050 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3600
Practice Address - Country:US
Practice Address - Phone:973-773-8820
Practice Address - Fax:972-472-3143
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00255300103G00000X, 103TC0700X, 103TF0200X, 103TH0100X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Not Answered103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCA757131Medicare ID - Type Unspecified
NJR33896Medicare UPIN