Provider Demographics
NPI:1437182243
Name:BARRETT, SOREN JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:SOREN
Middle Name:JAMES
Last Name:BARRETT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:SOREN
Other - Middle Name:JAMES
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 644114
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32964-4114
Mailing Address - Country:US
Mailing Address - Phone:772-538-1038
Mailing Address - Fax:
Practice Address - Street 1:3625 EAGLE DR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-1650
Practice Address - Country:US
Practice Address - Phone:772-538-1038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4688103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE0102Medicare PIN
FLS47761Medicare UPIN