Provider Demographics
NPI:1497857049
Name:BARBERA, LAWRENCE STEWART JR (PSYD, MSW)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:STEWART
Last Name:BARBERA
Suffix:JR
Gender:M
Credentials:PSYD, MSW
Other - Prefix:
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Mailing Address - Street 1:17 CHERRYDALE RD
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1771
Mailing Address - Country:US
Mailing Address - Phone:610-517-9522
Mailing Address - Fax:
Practice Address - Street 1:373 GLEN MILLS RD
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:PA
Practice Address - Zip Code:19373-1044
Practice Address - Country:US
Practice Address - Phone:610-517-9522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2321065000OtherIBC
PA228908000OtherKEYSTONE
PA7737327OtherAETNA