Provider Demographics
NPI:1053459396
Name:BARRY, DONALD J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:J
Last Name:BARRY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11305 GERMAN CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-1013
Mailing Address - Country:US
Mailing Address - Phone:630-408-4018
Mailing Address - Fax:708-839-9754
Practice Address - Street 1:11305 GERMAN CHURCH RD
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60480-1013
Practice Address - Country:US
Practice Address - Phone:630-408-4018
Practice Address - Fax:708-839-9754
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0023371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149-002337OtherSTATE LICENSE NUMBER