MEDICARE: LONNIE BARBACH

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	103TC0700X	Clinical Psychologist	PSY4838	CA

General Provider Information

NPI Number	:	1982012217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LONNIE BARBACH

Provider Business Mailing Address
First Line	:	60 PALM WAY
Second Line	:
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-2602
Country	:	US
Telephone Number	:	415-383-0755
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 PALM WAY
Second Line	:
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-2602
Country	:	US
Telephone Number	:	415-383-0755
Fax Number	:

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

Provider Enumeration Date	:	07/30/2014
Last Update Date	:	07/30/2014

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Directions to “ LONNIE BARBACH ” Practice Location

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