Provider Demographics
NPI:1649608076
Name:DUCKREY BARROT, TABITHA (LSW)
Entity type:Individual
Prefix:MS
First Name:TABITHA
Middle Name:
Last Name:DUCKREY BARROT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:
Other - Last Name:DUCKREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1 COOPER PLZ
Mailing Address - Street 2:SUITE 222
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1461
Mailing Address - Country:US
Mailing Address - Phone:856-669-9382
Mailing Address - Fax:856-361-1368
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:SUITE 222
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-669-9382
Practice Address - Fax:856-361-1368
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-22
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05789300104100000X
NJ44SC061174001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1568442309OtherCOOPER UNIVERSITY HOSPITAL
NJ164960807Medicaid