Provider Demographics
NPI:1528376514
Name:BARRERA, JOSE LUIS (ACSW)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:BARRERA
Suffix:
Gender:M
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 DOUGLAS DR STE 234
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4068
Mailing Address - Country:US
Mailing Address - Phone:510-384-7765
Mailing Address - Fax:
Practice Address - Street 1:30 DOUGLAS DR STE 234
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4068
Practice Address - Country:US
Practice Address - Phone:510-384-7765
Practice Address - Fax:925-372-4422
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32452104100000X
CA827551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker