MEDICARE: MRS. TRICIA LOUISE BARI-DOUGHERTY M.S.

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1639408784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRICIA LOUISE BARI-DOUGHERTY M.S.

Provider Business Mailing Address
First Line	:	312 W LOCUST LN
Second Line	:
City	:	KENNETT SQUARE
State	:	PA
Zip	:	19348-1637
Country	:	US
Telephone Number	:	610-444-1053
Fax Number	:

Provider Business Practice Location Address
First Line	:	85 OLD EAGLE SCHOOL RD
Second Line	:	SECOND FLOOR
City	:	STRAFFORD
State	:	PA
Zip	:	19087-2556
Country	:	US
Telephone Number	:	610-688-1636
Fax Number	:

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

Provider Enumeration Date	:	12/21/2009
Last Update Date	:	12/21/2009

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