Provider Demographics
NPI:1598090151
Name:BARANSAKA, DEOGRATIAS (BA)
Entity Type:Individual
Prefix:MR
First Name:DEOGRATIAS
Middle Name:
Last Name:BARANSAKA
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7215 W IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-6805
Mailing Address - Country:US
Mailing Address - Phone:623-760-8378
Mailing Address - Fax:623-594-8992
Practice Address - Street 1:7215 W IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-6805
Practice Address - Country:US
Practice Address - Phone:623-760-8378
Practice Address - Fax:623-594-8992
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4311101YM0800X
AZBH-4311251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health