Provider Demographics
NPI:1922770569
Name:LA BARRIE, RANDOLPH (BSW, MSW)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:
Last Name:LA BARRIE
Suffix:
Gender:M
Credentials:BSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 N GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63107-1804
Mailing Address - Country:US
Mailing Address - Phone:314-534-6624
Mailing Address - Fax:314-535-4394
Practice Address - Street 1:4220 N GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63107-1804
Practice Address - Country:US
Practice Address - Phone:314-534-6624
Practice Address - Fax:314-535-4394
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health