Provider Demographics
NPI:1467709550
Name:BARTHOLOMEW, JOSEPH JEROME (RRW5162)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JEROME
Last Name:BARTHOLOMEW
Suffix:
Gender:M
Credentials:RRW5162
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-1306
Mailing Address - Country:US
Mailing Address - Phone:775-336-9377
Mailing Address - Fax:
Practice Address - Street 1:551 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-1306
Practice Address - Country:US
Practice Address - Phone:775-336-9377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARW5162171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator