Provider Demographics
NPI:1710950787
Name:RIETER-BARRETT, KAREN M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:M
Last Name:RIETER-BARRETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:M
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4081 N HIDDEN COVE PLACE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749
Mailing Address - Country:US
Mailing Address - Phone:520-861-4063
Mailing Address - Fax:520-749-6425
Practice Address - Street 1:5930 E PIMA ST STE 200
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4351
Practice Address - Country:US
Practice Address - Phone:520-261-7422
Practice Address - Fax:520-326-8569
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10101104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ858243Medicaid
AZAZ105200OtherMEDICARE SUBMITTER ID AZ
AZZWCGCROtherGROUP MEDICARE #