Provider Demographics
NPI:1184967226
Name:BARRAGAN, DESERIE R (PSYD)
Entity type:Individual
Prefix:DR
First Name:DESERIE
Middle Name:R
Last Name:BARRAGAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 FROSTCLIFF LN
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9414
Mailing Address - Country:US
Mailing Address - Phone:805-704-9588
Mailing Address - Fax:
Practice Address - Street 1:116 FROSTCLIFF LN
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9414
Practice Address - Country:US
Practice Address - Phone:805-704-9588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6289103TC0700X, 103TC2200X, 103TF0200X
CAPSY17455103TC2200X, 103TF0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic