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General NPI Number Information
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NPI Number | 1245744507
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Entity Type | Organization
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Legal Business Name | JUDITH CARNEY PSYD LLC
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Dates
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Enumeration Date | 11/24/2017
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Last Update Date | 11/24/2017
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Provider Practice Location Address
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Address Line | 245 SW NORTH WAKEFIELD CIR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-5443
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Country | US
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Telephone | 561-577-2352
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Fax |
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Provider Business Mailing Address
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Address Line | 245 SW NORTH WAKEFIELD CIR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-5443
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Country | US
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Telephone | 561-577-2352
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JUDITH HELENE CARNEY
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Credential | PSYD
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Telephone | 561-577-2352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY9240
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License Number State | FL
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