Healthcare Provider Details

I. General information

NPI: 1811704331
Provider Name (Legal Business Name): BLANCA MARIA BARRERA MORALES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BLANCA MARIA BARRERA

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8804 PATTERSON AVE
RICHMOND VA
23229-6361
US

IV. Provider business mailing address

5612 STONEACRE PL
GLEN ALLEN VA
23059-5377
US

V. Phone/Fax

Practice location:
  • Phone: 804-592-6311
  • Fax:
Mailing address:
  • Phone: 281-467-2694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904012673
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: