Provider Demographics
NPI:1104375658
Name:BARR, MITCHELL B (CASAC)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:B
Last Name:BARR
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 ROME AVE
Mailing Address - Street 2:APT. 12B
Mailing Address - City:BEDFORD HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10507-2328
Mailing Address - Country:US
Mailing Address - Phone:914-299-7827
Mailing Address - Fax:
Practice Address - Street 1:39 ROME AVE
Practice Address - Street 2:APT. 12B
Practice Address - City:BEDFORD HILLS
Practice Address - State:NY
Practice Address - Zip Code:10507-2328
Practice Address - Country:US
Practice Address - Phone:914-299-7827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCASAC-24761101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)