Provider Demographics
NPI:1487868618
Name:BARTH, KERRY L (PSYD, MFT)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:L
Last Name:BARTH
Suffix:
Gender:F
Credentials:PSYD, MFT
Other - Prefix:MISS
Other - First Name:KERRY
Other - Middle Name:L
Other - Last Name:ESSAKOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:5565 GROSSMONT CENTER DR
Mailing Address - Street 2:BUILD. 1, STE 223
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3020
Mailing Address - Country:US
Mailing Address - Phone:619-800-8438
Mailing Address - Fax:619-741-7798
Practice Address - Street 1:5565 GROSSMONT CENTER DR
Practice Address - Street 2:BUILD. 1, STE 223
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3020
Practice Address - Country:US
Practice Address - Phone:619-800-8438
Practice Address - Fax:619-741-7798
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF #51864106H00000X
CAMFC #48425106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist