Provider Demographics
NPI:1033675764
Name:BARNES, CARL JR
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:BARNES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 SOLOMONS ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20639-3727
Mailing Address - Country:US
Mailing Address - Phone:717-434-2336
Mailing Address - Fax:
Practice Address - Street 1:1375 MOUNT OLIVET RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-2509
Practice Address - Country:US
Practice Address - Phone:202-735-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG500826021041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCLG50082602Medicaid