Healthcare Provider Details

I. General information

NPI: 1003055500
Provider Name (Legal Business Name): RAYMOND BARRETT LPC, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2009
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 S MAIN ST
CANANDAIGUA NY
14424-2246
US

IV. Provider business mailing address

261 S PEARL ST
CANANDAIGUA NY
14424-1749
US

V. Phone/Fax

Practice location:
  • Phone: 585-857-6122
  • Fax: 585-905-3239
Mailing address:
  • Phone: 585-857-6122
  • Fax: 585-905-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005308
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC006295
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8823
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: