Provider Demographics
NPI:1518096940
Name:BARRETT, AUDREY DAWN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:DAWN
Last Name:BARRETT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 UNIVERSITY AVE # 638
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3398
Mailing Address - Country:US
Mailing Address - Phone:858-386-9392
Mailing Address - Fax:
Practice Address - Street 1:3633 CAMINO DEL RIO S STE 204
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4048
Practice Address - Country:US
Practice Address - Phone:858-386-9392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA228021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical