Provider Demographics
NPI:1215019393
Name:BARBA, GERALD FRED (PHD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:FRED
Last Name:BARBA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:JERRY
Other - Middle Name:FRED
Other - Last Name:BARBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:9449 E. IMPERIAL HIGHWAY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242
Mailing Address - Country:US
Mailing Address - Phone:562-657-2055
Mailing Address - Fax:562-429-2559
Practice Address - Street 1:9449 E. IMPERIAL HIGHWAY
Practice Address - Street 2:SUITE 206
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242
Practice Address - Country:US
Practice Address - Phone:562-657-2055
Practice Address - Fax:562-429-2559
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19013103TC0700X
CAPSY19015103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical