Provider Demographics
NPI:1245402841
Name:BARNES, MIRIAM
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:BARNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 MONTAGUE ST
Mailing Address - Street 2:SUITE 418
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3610
Mailing Address - Country:US
Mailing Address - Phone:718-875-5625
Mailing Address - Fax:718-875-6876
Practice Address - Street 1:189 MONTAGUE ST
Practice Address - Street 2:SUITE 436
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3610
Practice Address - Country:US
Practice Address - Phone:718-875-7510
Practice Address - Fax:718-643-3455
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076478-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical