Provider Demographics
NPI:1801079538
Name:SEVERE, BARRY BERNARD
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:BERNARD
Last Name:SEVERE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6370 MAGNOLIA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2406
Mailing Address - Country:US
Mailing Address - Phone:951-358-5930
Mailing Address - Fax:
Practice Address - Street 1:6370 MAGNOLIA AVE STE 200
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2406
Practice Address - Country:US
Practice Address - Phone:951-358-5930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker