MEDICARE: BARRY GILLIAM CRS

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1477190981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRY GILLIAM CRS

Provider Business Mailing Address
First Line	:	1789 S BRADDOCK AVE STE 550
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15218-1880
Country	:	US
Telephone Number	:	412-723-1749
Fax Number	:	412-346-4319

Provider Business Practice Location Address
First Line	:	1789 S BRADDOCK AVE STE 550
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15218-1880
Country	:	US
Telephone Number	:	412-723-1749
Fax Number	:	412-346-4319

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

Provider Enumeration Date	:	12/03/2019
Last Update Date	:	09/16/2022

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