Healthcare Provider Details

I. General information

NPI: 1376557322
Provider Name (Legal Business Name): BARTON S SLOAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 VISTA CIR
BEDFORD VA
24523-1243
US

IV. Provider business mailing address

1806 VISTA CIR
BEDFORD VA
24523-1243
US

V. Phone/Fax

Practice location:
  • Phone: 907-250-9477
  • Fax: 360-205-3827
Mailing address:
  • Phone: 907-250-9477
  • Fax: 360-205-3827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number60579290
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904015171
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number197
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: