=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366267213
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REGINA M CARNEY MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2024
-----------------------------------------------------
Last Update Date | 11/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2677 NW 19TH ST
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33311-3340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-324-4255
-----------------------------------------------------
Fax | 954-212-2227
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7027 W BROWARD BLVD STE 768
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33317-2208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 754-704-6183
-----------------------------------------------------
Fax | 615-235-1139
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. REGINA M CARNEY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 754-704-6183
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084F0202X
-----------------------------------------------------
Taxonomy Name | Forensic Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------