Provider Demographics
NPI:1568550838
Name:BARKER, KENNETH B (LCSW)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:B
Last Name:BARKER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:KENNETH
Other - Middle Name:B
Other - Last Name:BARKER, LCSW, BCD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW BCD
Mailing Address - Street 1:10790 RANCHO BERNARDO RD.
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:858-554-6394
Mailing Address - Fax:
Practice Address - Street 1:5405 MOREHOUSE DR. SUITE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1292
Practice Address - Country:US
Practice Address - Phone:858-554-6394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS73061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABB539ZMedicare PIN
CAS02903Medicare UPIN