Provider Demographics
NPI:1356415368
Name:BARKO, PAUL ANDREW (LISW-S, LICDC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ANDREW
Last Name:BARKO
Suffix:
Gender:M
Credentials:LISW-S, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 BRIARFIELD BLVD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-8919
Mailing Address - Country:US
Mailing Address - Phone:419-866-2830
Mailing Address - Fax:419-866-2831
Practice Address - Street 1:3600 BRIARFIELD BLVD
Practice Address - Street 2:SUITE #3
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-8919
Practice Address - Country:US
Practice Address - Phone:419-866-2830
Practice Address - Fax:419-866-2831
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH81648101YA0400X
OHI.00014901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBASW15574Medicare PIN