Provider Demographics
NPI:1467469353
Name:BARR, CHARLES R (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:BARR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 N EL MOLINO AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101
Mailing Address - Country:US
Mailing Address - Phone:626-449-5589
Mailing Address - Fax:626-449-5465
Practice Address - Street 1:131 N EL MOLINO AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101
Practice Address - Country:US
Practice Address - Phone:626-449-5589
Practice Address - Fax:626-449-5465
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY06397103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY063970Medicaid
CACP6397Medicare ID - Type Unspecified