1487868618 NPI number — DR. KERRY L BARTH PSYD, MFT

Table of content: DR. KERRY L BARTH PSYD, MFT (NPI 1487868618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487868618 NPI number — DR. KERRY L BARTH PSYD, MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARTH
Provider First Name:
KERRY
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD, MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ESSAKOW
Provider Other First Name:
KERRY
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487868618
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5565 GROSSMONT CENTER DR
Provider Second Line Business Mailing Address:
BUILD. 1, STE 223
Provider Business Mailing Address City Name:
LA MESA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91942-3020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-800-8438
Provider Business Mailing Address Fax Number:
619-741-7798

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5565 GROSSMONT CENTER DR
Provider Second Line Business Practice Location Address:
BUILD. 1, STE 223
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-3020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-800-8438
Provider Business Practice Location Address Fax Number:
619-741-7798
Provider Enumeration Date:
05/09/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  IMF #51864 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: MFC #48425 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)