Provider Demographics
NPI:1275505323
Name:BARR, BETTY J (LCSW)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:J
Last Name:BARR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:J
Other - Last Name:BRITTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:645 S ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2353
Mailing Address - Country:US
Mailing Address - Phone:812-339-1691
Mailing Address - Fax:812-337-2438
Practice Address - Street 1:1156 OLD STATE ROAD 46
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IN
Practice Address - Zip Code:47448-9211
Practice Address - Country:US
Practice Address - Phone:812-988-2258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002847A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
541910C1Medicare PIN
IN143230AAMedicare ID - Type Unspecified