Provider Demographics
NPI:1457866055
Name:BARTH, LEWIS M (PHD, PSYD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:M
Last Name:BARTH
Suffix:
Gender:M
Credentials:PHD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4826 ANDASOL AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3801
Mailing Address - Country:US
Mailing Address - Phone:818-613-8494
Mailing Address - Fax:818-783-4877
Practice Address - Street 1:4826 ANDASOL AVE
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3801
Practice Address - Country:US
Practice Address - Phone:818-613-8494
Practice Address - Fax:818-783-4877
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARP258102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst