1508909813 NPI number — MRS. SANDRA M BARRETT LPC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508909813 NPI number — MRS. SANDRA M BARRETT LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARRETT
Provider First Name:
SANDRA
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
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:
1508909813
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 16TH ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20020-5630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-678-0894
Provider Business Mailing Address Fax Number:
202-678-0894

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1720 MINNESOTA AVE SE
Provider Second Line Business Practice Location Address:
# 6
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20020-4724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-210-9098
Provider Business Practice Location Address Fax Number:
202-678-0894
Provider Enumeration Date:
02/15/2007

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: 101YP2500X , with the licence number:  PRC 374 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 119896 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22476 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".




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