MEDICARE: JAMES MARTIN BARRY MSW LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C000674	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	13399	OTHER	NC	BCBS
3	561834499	OTHER	NC	TRICARE

General Provider Information

NPI Number	:	1356319644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES MARTIN BARRY MSW LCSW

Provider Business Mailing Address
First Line	:	PO BOX 9728
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-9091
Country	:	US
Telephone Number	:	910-485-0940
Fax Number	:	910-323-6030

Provider Business Practice Location Address
First Line	:	2018 FORT BRAGG RD
Second Line	:	SUITE 114A
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-7037
Country	:	US
Telephone Number	:	910-485-0940
Fax Number	:	910-323-6030

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	10/03/2011

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