Provider Demographics
NPI:1003260639
Name:JUDY BARRAGAN
Entity Type:Organization
Organization Name:JUDY BARRAGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-355-9327
Mailing Address - Street 1:7518 PATTERSON CT
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6683
Mailing Address - Country:US
Mailing Address - Phone:240-355-9327
Mailing Address - Fax:
Practice Address - Street 1:1438 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-6493
Practice Address - Country:US
Practice Address - Phone:443-609-4302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD136851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD882062Medicaid