Provider Demographics
NPI:1972649267
Name:BARRON, LIZ (LICSW)
Entity Type:Individual
Prefix:
First Name:LIZ
Middle Name:
Last Name:BARRON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MOUNT PLEASANT AVE # R
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-4205
Mailing Address - Country:US
Mailing Address - Phone:978-283-2096
Mailing Address - Fax:
Practice Address - Street 1:107 MOUNT PLEASANT AVE # R
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-4205
Practice Address - Country:US
Practice Address - Phone:978-283-2096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900006691041C0700X
MA1002781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009279Medicaid
VT38986OtherBCBS OF VT
MAP01699OtherBCBS OF MA