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General NPI Number Information
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NPI Number | 1467990002
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Entity Type | Individual
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Provider Name | KERRY BAHARANYI LICSW
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Gender | Female
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Dates
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Enumeration Date | 02/02/2017
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Last Update Date | 02/02/2017
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Provider Practice Location Address
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Address Line | 122 N 20TH ST BUILDING #26
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City | OPELIKA
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State | AL
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Zip | 36801-5442
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Country | US
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Telephone | 334-749-3593
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Fax | 334-749-3594
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Provider Business Mailing Address
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Address Line | 409 E THACH AVE
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City | AUBURN
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State | AL
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Zip | 36830-5539
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Country | US
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Telephone | 334-707-6007
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3830C
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License Number State | AL
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