Provider Demographics
NPI:1245614031
Name:BARRIOS, JOSE
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:BARRIOS
Suffix:
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 1:22 ELIZABETH AVE.
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07407
Mailing Address - Country:US
Mailing Address - Phone:201-663-5655
Mailing Address - Fax:
Practice Address - Street 1:22 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-3018
Practice Address - Country:US
Practice Address - Phone:201-663-5655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-12
Last Update Date:2015-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05946200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker