Provider Demographics
NPI:1073677290
Name:BARTA, PEGGY LENORE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:LENORE
Last Name:BARTA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 S 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-5257
Mailing Address - Country:US
Mailing Address - Phone:406-556-1037
Mailing Address - Fax:
Practice Address - Street 1:1704 W BABCOCK ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4058
Practice Address - Country:US
Practice Address - Phone:406-556-1037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical