=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861410672
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT MICHAEL CARNEY PSYD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2006
-----------------------------------------------------
Last Update Date | 08/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4320 FOREST PARK AVE STE 301
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63108-2979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-286-1300
-----------------------------------------------------
Fax | 314-286-1301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 660 S EUCLID AVE CB 8134
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63110-1010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-286-1700
-----------------------------------------------------
Fax | 314-396-8266
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 00225
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------