Provider Demographics
NPI:1023001328
Name:PETRATOS, BARBARA JUDITH (MS DSW LCSW)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:JUDITH
Last Name:PETRATOS
Suffix:
Gender:F
Credentials:MS DSW LCSW
Other - Prefix:DR
Other - First Name:BARBARA
Other - Middle Name:JUDITH
Other - Last Name:DIONIS PETRATOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS DSW LCSW
Mailing Address - Street 1:928 BROADWAY STE OFFICE5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6008
Mailing Address - Country:US
Mailing Address - Phone:212-242-5716
Mailing Address - Fax:212-924-4002
Practice Address - Street 1:104 E 40TH ST
Practice Address - Street 2:STE 804
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-242-5716
Practice Address - Fax:212-924-4002
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02147711041C0700X
NYPRO214771104100000X
NYPR0214771103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN08861Medicare ID - Type Unspecified