Provider Demographics
NPI:1073273249
Name:BARNES, MINDY SUE (LMSW)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:SUE
Last Name:BARNES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:SUE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:173 BURBANK AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-3002
Mailing Address - Country:US
Mailing Address - Phone:570-396-6239
Mailing Address - Fax:
Practice Address - Street 1:173 BURBANK AVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-3002
Practice Address - Country:US
Practice Address - Phone:570-396-6239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104806104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker