Provider Demographics
NPI:1205482791
Name:BARRETT, BERTHA FREEMAN (MA)
Entity type:Individual
Prefix:
First Name:BERTHA
Middle Name:FREEMAN
Last Name:BARRETT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:BERTHA
Other - Middle Name:ELAINE
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3015 PARENTAL HOME RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5768
Mailing Address - Country:US
Mailing Address - Phone:904-720-0387
Mailing Address - Fax:904-724-8513
Practice Address - Street 1:3015 PARENTAL HOME RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5768
Practice Address - Country:US
Practice Address - Phone:904-720-0387
Practice Address - Fax:904-724-8513
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health