Provider Demographics
NPI:1922407345
Name:BARNES, KANISHA R (LCSW-C, LICSW)
Entity Type:Individual
Prefix:
First Name:KANISHA
Middle Name:R
Last Name:BARNES
Suffix:
Gender:F
Credentials:LCSW-C, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10530 CAMPUS WAY S UNIT 1118
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1309
Mailing Address - Country:US
Mailing Address - Phone:443-743-2563
Mailing Address - Fax:
Practice Address - Street 1:2908 MUESERBUSH CT
Practice Address - Street 2:
Practice Address - City:GLENARDEN
Practice Address - State:MD
Practice Address - Zip Code:20706-5514
Practice Address - Country:US
Practice Address - Phone:443-743-2563
Practice Address - Fax:301-591-6268
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD199451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical