Provider Demographics
NPI:1447569546
Name:BARNES, MARY ELLEN (RAS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:BARNES
Suffix:
Gender:F
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 PALOS VERDES DR N
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-2525
Mailing Address - Country:US
Mailing Address - Phone:310-541-6350
Mailing Address - Fax:
Practice Address - Street 1:4020 PALOS VERDES DR N
Practice Address - Street 2:SUITE 201
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-2525
Practice Address - Country:US
Practice Address - Phone:310-541-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB0610311618101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)