Provider Demographics
NPI:1871820068
Name:DOUGLASS, BARBARA JEAN A (LCSW)
Entity Type:Individual
Prefix:
First Name:BARBARA JEAN
Middle Name:A
Last Name:DOUGLASS
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 1:305 LIGHTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-4005
Mailing Address - Country:US
Mailing Address - Phone:585-208-6765
Mailing Address - Fax:
Practice Address - Street 1:305 LIGHTHOUSE DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590
Practice Address - Country:US
Practice Address - Phone:585-208-6765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0792091041C0700X
CA830921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY079209Medicaid
CA83092Medicaid