Healthcare Provider Details

I. General information

NPI: 1689408742
Provider Name (Legal Business Name): RAQUEL LYN BARKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 SE INDIAN ST
STUART FL
34997-5765
US

IV. Provider business mailing address

1131 SE INDIAN ST
STUART FL
34997-5765
US

V. Phone/Fax

Practice location:
  • Phone: 772-210-0913
  • Fax: 772-210-0871
Mailing address:
  • Phone: 772-210-0913
  • Fax: 772-210-0871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW19184
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: