Provider Demographics
NPI:1780415257
Name:BARE, JUDY LYNN
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:LYNN
Last Name:BARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 TEEL RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2445
Mailing Address - Country:US
Mailing Address - Phone:304-222-2124
Mailing Address - Fax:
Practice Address - Street 1:320 TEEL RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2445
Practice Address - Country:US
Practice Address - Phone:304-222-2124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker