MEDICARE: TIMOTHY A CARNEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1184505307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMOTHY A CARNEY

Provider Business Mailing Address
First Line	:	1017 W GLEN OAKS LN STE 167
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-3317
Country	:	US
Telephone Number	:	920-360-3469
Fax Number	:

Provider Business Practice Location Address
First Line	:	1017 W GLEN OAKS LN STE 167
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-3317
Country	:	US
Telephone Number	:	920-360-3469
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIMOTHY A CARNEY
Credential	:
Telephone Number	:	920-360-3469

Provider Enumeration Date	:	09/12/2025
Last Update Date	:	06/05/2026

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