Provider Demographics
NPI:1790997088
Name:BARR, ROGER T (EDD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:T
Last Name:BARR
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 DANIELS WAY
Mailing Address - Street 2:
Mailing Address - City:WOOLWICH TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08085
Mailing Address - Country:US
Mailing Address - Phone:856-467-1125
Mailing Address - Fax:856-467-6884
Practice Address - Street 1:488 N GLASSBORO ROAD
Practice Address - Street 2:
Practice Address - City:WOODBURY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08097
Practice Address - Country:US
Practice Address - Phone:856-848-3279
Practice Address - Fax:856-467-6884
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ355100097000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical