Healthcare Provider Details

I. General information

NPI: 1154484244
Provider Name (Legal Business Name): SHIRA J.S. BARNETT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LINCOLN STREET SUITE 4
BATH ME
04530
US

IV. Provider business mailing address

P.O. BOX 1056
ROCKPORT ME
04856
US

V. Phone/Fax

Practice location:
  • Phone: 207-446-9495
  • Fax:
Mailing address:
  • Phone: 207-446-9495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC5812
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number117654
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: