=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154484244
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHIRA J.S. BARNETT LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2006
-----------------------------------------------------
Last Update Date | 09/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 LINCOLN STREET SUITE 4
-----------------------------------------------------
City | BATH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-446-9495
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 1056
-----------------------------------------------------
City | ROCKPORT
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-446-9495
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LC5812
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 117654
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------