Provider Demographics
NPI:1861410672
Name:CARNEY, ROBERT MICHAEL (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:CARNEY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8134
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-286-1700
Mailing Address - Fax:314-396-8266
Practice Address - Street 1:4320 FOREST PARK AVE
Practice Address - Street 2:STE 301
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2979
Practice Address - Country:US
Practice Address - Phone:314-286-1300
Practice Address - Fax:314-286-1301
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00225103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493697304Medicaid
MO000070559Medicaid