Provider Demographics
NPI:1932142494
Name:BARNETT, CANICE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:CANICE
Middle Name:M
Last Name:BARNETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3884 WOODTHRUSH RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-1527
Mailing Address - Country:US
Mailing Address - Phone:330-329-2063
Mailing Address - Fax:330-665-3142
Practice Address - Street 1:3884 WOODTHRUSH RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-1527
Practice Address - Country:US
Practice Address - Phone:330-329-2063
Practice Address - Fax:330-665-3142
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4525103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0936661Medicaid
OHBAC13191Medicare ID - Type Unspecified