Provider Demographics
NPI:1356340459
Name:CARNEY, MARK P (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:P
Last Name:CARNEY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1601 CONCORD PIKE
Mailing Address - Street 2:SUITE 50
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3612
Mailing Address - Country:US
Mailing Address - Phone:302-425-4417
Mailing Address - Fax:302-425-0194
Practice Address - Street 1:614 LOVEVILLE RD STE F1A
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-1623
Practice Address - Country:US
Practice Address - Phone:302-235-1860
Practice Address - Fax:302-425-0194
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1- 0000662103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEPROV000082241Medicaid