Provider Demographics
NPI:1568282515
Name:BARNER, CARLY
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:BARNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 AMBLEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-1106
Mailing Address - Country:US
Mailing Address - Phone:585-943-2721
Mailing Address - Fax:
Practice Address - Street 1:253 EASTERLY PKWY STE 205
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-6301
Practice Address - Country:US
Practice Address - Phone:814-996-1282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAMF000030106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist