Provider Demographics
NPI:1245448075
Name:BARNES, ANDY (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:BARNES
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 KEITH AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-5724
Mailing Address - Country:US
Mailing Address - Phone:401-785-0608
Mailing Address - Fax:401-785-4062
Practice Address - Street 1:50 KEITH AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-5724
Practice Address - Country:US
Practice Address - Phone:401-785-0608
Practice Address - Fax:401-785-4062
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW 4831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIAB09014Medicaid