Provider Demographics
NPI:1053812537
Name:NEYRA, CARMEN JULIA (PHD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:JULIA
Last Name:NEYRA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4939 LOWER ROSWELL RD BLDG C
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4338
Mailing Address - Country:US
Mailing Address - Phone:404-915-3987
Mailing Address - Fax:770-578-0860
Practice Address - Street 1:4939 LOWER ROSWELL RD BLDG C
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4338
Practice Address - Country:US
Practice Address - Phone:404-915-3987
Practice Address - Fax:770-578-0860
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002108103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical