1336261239 NPI number — MRS. DERITHA MARBORY BARBER LMSW

Table of content: MRS. DERITHA MARBORY BARBER LMSW (NPI 1336261239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336261239 NPI number — MRS. DERITHA MARBORY BARBER LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARBER
Provider First Name:
DERITHA
Provider Middle Name:
MARBORY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336261239
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4710 HIGHWAY 528
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEIDELBERG
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39439-4953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-787-3832
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2103 13TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39301-4045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-482-3275
Provider Business Practice Location Address Fax Number:
601-482-2852
Provider Enumeration Date:
04/04/2007

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: 104100000X , with the licence number:  M5745 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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