MEDICARE: RADINE BARGE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1166	CO

General Provider Information

NPI Number	:	1144301771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RADINE BARGE PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 6884
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80934-6884
Country	:	US
Telephone Number	:	719-597-8990
Fax Number	:	719-597-3608

Provider Business Practice Location Address
First Line	:	3055 AUSTIN BLUFFS PKWY STE A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-5758
Country	:	US
Telephone Number	:	719-597-8990
Fax Number	:	719-597-3608

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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