Healthcare Provider Details

I. General information

NPI: 1548725203
Provider Name (Legal Business Name): MARIO DESHAUN BARNES MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FRANKLIN ST
HAMPTON VA
23669-3568
US

IV. Provider business mailing address

1 FRANKLIN ST
HAMPTON VA
23669-3568
US

V. Phone/Fax

Practice location:
  • Phone: 757-240-7035
  • Fax:
Mailing address:
  • Phone: 757-240-7035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904011005
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: