Provider Demographics
NPI:1609059468
Name:BARRETT, KENNETH A (MSW)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:A
Last Name:BARRETT
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1424
Mailing Address - Country:US
Mailing Address - Phone:314-371-6500
Mailing Address - Fax:
Practice Address - Street 1:3675 W OUTER RD
Practice Address - Street 2:SUITE 203
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-5232
Practice Address - Country:US
Practice Address - Phone:314-898-0102
Practice Address - Fax:636-296-3249
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW25891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical