Provider Demographics
NPI:1639819824
Name:BARDA, LATOSSIA DELORES (CSW)
Entity Type:Individual
Prefix:
First Name:LATOSSIA
Middle Name:DELORES
Last Name:BARDA
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:LATOSSIA
Other - Middle Name:DELORES
Other - Last Name:KRASCHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1004 E CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-5630
Mailing Address - Country:US
Mailing Address - Phone:550-274-3431
Mailing Address - Fax:
Practice Address - Street 1:1396 W HERNDON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-7126
Practice Address - Country:US
Practice Address - Phone:559-256-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1152781041C0700X, 104100000X
CA743911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker