MEDICARE: MS. LAURIE BARRON MSS, 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	CW006558L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	001661659	OTHER	BLUE CROSS PERSONAL CHOIC
2	065174000	OTHER	AMERIHEALTH
3	7079270	OTHER	AETNA

General Provider Information

NPI Number	:	1790765964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURIE BARRON MSS, LCSW

Provider Business Mailing Address
First Line	:	408 MEADOWBROOK LN
Second Line	:
City	:	ERDENHEIM
State	:	PA
Zip	:	19038-8225
Country	:	US
Telephone Number	:	215-836-9121
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 S 17TH ST
Second Line	:	SUITE 1509
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6231
Country	:	US
Telephone Number	:	215-836-9121
Fax Number	:

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

Provider Enumeration Date	:	01/22/2006
Last Update Date	:	03/25/2009

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