Healthcare Provider Details

I. General information

NPI: 1861410672
Provider Name (Legal Business Name): ROBERT MICHAEL CARNEY PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/23/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 FOREST PARK AVE STE 301
SAINT LOUIS MO
63108-2979
US

IV. Provider business mailing address

660 S EUCLID AVE CB 8134
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-1300
  • Fax: 314-286-1301
Mailing address:
  • Phone: 314-286-1700
  • Fax: 314-396-8266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number00225
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: