Provider Demographics
NPI:1164960613
Name:BARAKA, RICHARD III
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:BARAKA
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 EVERGREEN RD
Mailing Address - Street 2:APT # 19B
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2445
Mailing Address - Country:US
Mailing Address - Phone:973-698-2364
Mailing Address - Fax:
Practice Address - Street 1:172 EVERGREEN RD APT 19B
Practice Address - Street 2:APT # 19B
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2479
Practice Address - Country:US
Practice Address - Phone:973-647-2622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-04
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00148200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)