Provider Demographics
NPI:1255094710
Name:BARKER, RAPHAEL A (MFT)
Entity Type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:A
Last Name:BARKER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 ORDWAY ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2518
Mailing Address - Country:US
Mailing Address - Phone:415-579-1766
Mailing Address - Fax:
Practice Address - Street 1:1240 ORDWAY ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2518
Practice Address - Country:US
Practice Address - Phone:415-579-1766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123865101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health