Provider Demographics
NPI:1710399100
Name:DEMETER, BARRY
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:DEMETER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6166 VESPER AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2851
Mailing Address - Country:US
Mailing Address - Phone:818-997-0414
Mailing Address - Fax:818-785-3457
Practice Address - Street 1:24460 LYONS AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2347
Practice Address - Country:US
Practice Address - Phone:661-253-9400
Practice Address - Fax:661-253-9403
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARW7613101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)