Healthcare Provider Details

I. General information

NPI: 1184505307
Provider Name (Legal Business Name): TIMOTHY A CARNEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 W GLEN OAKS LN STE 167
MEQUON WI
53092-3317
US

IV. Provider business mailing address

1017 W GLEN OAKS LN STE 167
MEQUON WI
53092-3317
US

V. Phone/Fax

Practice location:
  • Phone: 262-305-9438
  • Fax:
Mailing address:
  • Phone: 262-305-9438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY A CARNEY
Title or Position: OWNER
Credential:
Phone: 262-305-9438