Provider Demographics
NPI:1326332644
Name:BARKER, ELYSE LAURIE (MSW)
Entity Type:Individual
Prefix:MS
First Name:ELYSE
Middle Name:LAURIE
Last Name:BARKER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:ELYSE
Other - Middle Name:LAURIE
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:88 GREAT HILLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MOODUS
Mailing Address - State:CT
Mailing Address - Zip Code:06469-1217
Mailing Address - Country:US
Mailing Address - Phone:860-873-2143
Mailing Address - Fax:
Practice Address - Street 1:88 GREAT HILLWOOD RD
Practice Address - Street 2:
Practice Address - City:MOODUS
Practice Address - State:CT
Practice Address - Zip Code:06469-1217
Practice Address - Country:US
Practice Address - Phone:860-873-2143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor