Provider Demographics
NPI:1356319644
Name:BARRY, JAMES MARTIN (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MARTIN
Last Name:BARRY
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9728
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-9091
Mailing Address - Country:US
Mailing Address - Phone:910-485-0940
Mailing Address - Fax:910-323-6030
Practice Address - Street 1:2018 FORT BRAGG RD
Practice Address - Street 2:SUITE 114A
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-7037
Practice Address - Country:US
Practice Address - Phone:910-485-0940
Practice Address - Fax:910-323-6030
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0006741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002084Medicaid
NC13399OtherBCBS
NC561834499OtherTRICARE
NC561834499OtherTRICARE
R41718Medicare UPIN