Provider Demographics
NPI:1093358285
Name:GAYNOR, BARRY CLIFFORD (LCSW, MSW, MDIV)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:CLIFFORD
Last Name:GAYNOR
Suffix:
Gender:M
Credentials:LCSW, MSW, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 FOULK RD STE 104
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2748
Mailing Address - Country:US
Mailing Address - Phone:302-478-1450
Mailing Address - Fax:302-478-1430
Practice Address - Street 1:1415 FOULK RD STE 104
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2748
Practice Address - Country:US
Practice Address - Phone:302-478-1450
Practice Address - Fax:302-478-1430
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00015201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE434778Medicaid
DE1316329261Medicaid