MEDICARE: DYLAN CARNEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	37AC00602400	NJ

General Provider Information

NPI Number	:	1356063788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DYLAN CARNEY

Provider Business Mailing Address
First Line	:	1523 ELLSWORTH ST UNIT 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-3109
Country	:	US
Telephone Number	:	609-617-2605
Fax Number	:

Provider Business Practice Location Address
First Line	:	1523 ELLSWORTH ST UNIT 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-3109
Country	:	US
Telephone Number	:	609-617-2605
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2022
Last Update Date	:	09/13/2022

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Directions to “ DYLAN CARNEY ” Practice Location

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