Provider Demographics
NPI:1720296056
Name:BARGE, JOANNE PATRICIA (PHD, MSED)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:PATRICIA
Last Name:BARGE
Suffix:
Gender:F
Credentials:PHD, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12011 SAN VICENTE BLVD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4926
Mailing Address - Country:US
Mailing Address - Phone:310-472-2329
Mailing Address - Fax:310-472-1399
Practice Address - Street 1:12011 SAN VICENTE BLVD
Practice Address - Street 2:SUITE 510
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-4926
Practice Address - Country:US
Practice Address - Phone:310-472-2329
Practice Address - Fax:310-472-1399
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14116103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist