Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 35SI00255300 | NJ |
N | 103TC0700X | Clinical Psychologist | 35SI00255300 | NJ |
N | 103G00000X | Clinical Psychologist | 35SI00255300 | NJ |
N | 103TC0700X | Clinical Psychologist | 35SI00255300 | NJ |
N | 103TF0200X | Forensic Psychologist | 35SI00255300 | NJ |
N | 103TH0100X | Health Service | 35SI00255300 | NJ |
N | 103TR0400X | Rehabilitation Psychologist | 35SI00255300 | NJ |
NPI | 1013939032 |
---|---|
Provider Name | Dr. George Joseph Carnevale |
First Address | Maplewood, NJ 07040-3108 |
Second Address | Clifton, NJ 07013-3600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R33896 | (02) | NJ |