Provider Demographics
NPI:1881701035
Name:BARNES, MICHAEL N (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:N
Last Name:BARNES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 SAN JUAN WAY
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2754
Mailing Address - Country:US
Mailing Address - Phone:818-952-8941
Mailing Address - Fax:818-790-5069
Practice Address - Street 1:1369 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-2121
Practice Address - Country:US
Practice Address - Phone:818-952-8941
Practice Address - Fax:818-952-2313
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6396103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP6396Medicare ID - Type Unspecified