Healthcare Provider Details

I. General information

NPI: 1104608785
Provider Name (Legal Business Name): THOMAS BARLEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 LAKE SEYMOUR DR
MIDDLETOWN DE
19709-4665
US

IV. Provider business mailing address

723 LAKE SEYMOUR DR
MIDDLETOWN DE
19709-4665
US

V. Phone/Fax

Practice location:
  • Phone: 800-000-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AL BERRY
Title or Position: MANAGER
Credential:
Phone: 386-703-9084