Provider Demographics
NPI:1790887685
Name:PERRY, BARBARA JANET (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:JANET
Last Name:PERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2452 FENTON ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4551
Mailing Address - Country:US
Mailing Address - Phone:858-279-1223
Mailing Address - Fax:
Practice Address - Street 1:180 OTAY LAKES RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-2443
Practice Address - Country:US
Practice Address - Phone:858-279-1223
Practice Address - Fax:619-470-7030
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS131381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW13138Medicare ID - Type Unspecified