Healthcare Provider Details

I. General information

NPI: 1710148226
Provider Name (Legal Business Name): NIA BARNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date: 09/14/2021
Reactivation Date: 08/12/2026

III. Provider practice location address

2201 S BEVERLY GLEN BLVD APT 310
LOS ANGELES CA
90064-2476
US

IV. Provider business mailing address

2201 S BEVERLY GLEN BLVD APT 310
LOS ANGELES CA
90064-2476
US

V. Phone/Fax

Practice location:
  • Phone: 973-652-2368
  • Fax:
Mailing address:
  • Phone: 973-652-2368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC22765
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLPCC22765
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: