Provider Demographics
NPI:1790765964
Name:BARRON, LAURIE (MSS, LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:BARRON
Suffix:
Gender:F
Credentials:MSS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 MEADOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:ERDENHEIM
Mailing Address - State:PA
Mailing Address - Zip Code:19038-8225
Mailing Address - Country:US
Mailing Address - Phone:215-836-9121
Mailing Address - Fax:
Practice Address - Street 1:255 S 17TH ST
Practice Address - Street 2:SUITE 1509
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6231
Practice Address - Country:US
Practice Address - Phone:215-836-9121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-22
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW006558L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
001661659OtherBLUE CROSS PERSONAL CHOIC
065174000OtherAMERIHEALTH
7079270OtherAETNA
743451Medicare ID - Type Unspecified