Provider Demographics
NPI:1336233709
Name:GLEN, BARRIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARRIE
Middle Name:
Last Name:GLEN
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 1:2025 LONE OAK AVE
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-4620
Mailing Address - Country:US
Mailing Address - Phone:707-257-3146
Mailing Address - Fax:707-257-1473
Practice Address - Street 1:1303 JEFFERSON ST STE 600A
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2473
Practice Address - Country:US
Practice Address - Phone:707-254-1879
Practice Address - Fax:707-257-1473
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14323103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical