Healthcare Provider Details

I. General information

NPI: 1366424871
Provider Name (Legal Business Name): MARY B CARMAN LP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 E 1ST ST
NEWTON KS
67114-5010
US

IV. Provider business mailing address

1901 E 1ST ST
NEWTON KS
67114-5010
US

V. Phone/Fax

Practice location:
  • Phone: 316-284-6400
  • Fax: 316-284-6491
Mailing address:
  • Phone: 316-284-6400
  • Fax: 316-284-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number0407
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: