Healthcare Provider Details

I. General information

NPI: 1780230433
Provider Name (Legal Business Name): CAROLYNNE ELIZABETH BARON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA SALT LAKE CITY HEALTHCARE SYSTEM 500 FOOTHILL DRIVE
SALT LAKE CITY UT
84148-0001
US

IV. Provider business mailing address

1920 CANYONS RESORT DR APT 35A
PARK CITY UT
84098-6705
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-1565
  • Fax:
Mailing address:
  • Phone: 603-286-0501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number11024408-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: