Provider Demographics
NPI:1447425145
Name:BARNEY, MARY BERNADETTE (CSAC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:BERNADETTE
Last Name:BARNEY
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N2150 KESAEHKAHTEK RD
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:WI
Mailing Address - Zip Code:54128-9602
Mailing Address - Country:US
Mailing Address - Phone:715-799-3835
Mailing Address - Fax:
Practice Address - Street 1:N2150 KESAEHKAHTEK
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:WI
Practice Address - Zip Code:54128
Practice Address - Country:US
Practice Address - Phone:715-799-3835
Practice Address - Fax:715-799-3836
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1715101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39367500Medicaid