=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144301771
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RADINE BARGE PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3055 AUSTIN BLUFFS PKWY STE A
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80918-5758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-597-8990
-----------------------------------------------------
Fax | 719-597-3608
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6884
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80934-6884
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-597-8990
-----------------------------------------------------
Fax | 719-597-3608
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 1166
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------