Provider Demographics
NPI:1912566043
Name:BARKLEY, LAVIDA (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:
First Name:LAVIDA
Middle Name:
Last Name:BARKLEY
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 NOTT ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2618
Mailing Address - Country:US
Mailing Address - Phone:518-348-9791
Mailing Address - Fax:
Practice Address - Street 1:1305 NOTT ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2618
Practice Address - Country:US
Practice Address - Phone:518-348-9791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management