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General NPI Number Information
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NPI Number | 1518036268
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Entity Type | Individual
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Provider Name | LARAE ANN BARNES LISW
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Gender | Female
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2149 COLLINGWOOD BLVD
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City | TOLEDO
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State | OH
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Zip | 43620-1652
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Country | US
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Telephone | 419-243-9178
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Fax | 419-243-4450
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Provider Business Mailing Address
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Address Line | 12714 IDA WEST RD
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City | PETERSBURG
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State | MI
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Zip | 49270-9526
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Country | US
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Telephone | 734-625-0075
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Fax | 419-243-4450
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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 | I 0005069
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License Number State | OH
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