Healthcare Provider Details

I. General information

NPI: 1770277121
Provider Name (Legal Business Name): SARITA BARNES ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 HAMPTON DR
VENICE CA
90291-2623
US

IV. Provider business mailing address

1837 N ALEXANDRIA AVE APT 202
LOS ANGELES CA
90027-4024
US

V. Phone/Fax

Practice location:
  • Phone: 310-396-6468
  • Fax:
Mailing address:
  • Phone: 323-704-6924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116280
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: