Provider Demographics
NPI:1689738510
Name:CAIN, BARBARA CAROLE
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:CAROLE
Last Name:CAIN
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 1:1844 OAK HOLLOW DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-5924
Mailing Address - Country:US
Mailing Address - Phone:231-922-7134
Mailing Address - Fax:231-933-6378
Practice Address - Street 1:1844 OAK HOLLOW DR
Practice Address - Street 2:SUITE B
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-5924
Practice Address - Country:US
Practice Address - Phone:231-922-7134
Practice Address - Fax:231-933-6378
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010638501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI24130003Medicare ID - Type Unspecified