Provider Demographics
NPI:1619758752
Name:BAREFOOT, ALIA
Entity Type:Individual
Prefix:
First Name:ALIA
Middle Name:
Last Name:BAREFOOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 ABNER LN
Mailing Address - Street 2:
Mailing Address - City:KILLINGWORTH
Mailing Address - State:CT
Mailing Address - Zip Code:06419-1153
Mailing Address - Country:US
Mailing Address - Phone:203-350-9798
Mailing Address - Fax:
Practice Address - Street 1:56 ABNER LN
Practice Address - Street 2:
Practice Address - City:KILLINGWORTH
Practice Address - State:CT
Practice Address - Zip Code:06419-1153
Practice Address - Country:US
Practice Address - Phone:860-663-3036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT58.0126621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical