MEDICARE: BARRETT ENTERPRISE

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	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1609059468	OTHER	MO	CAQH

General Provider Information

NPI Number	:	1265929335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARRETT ENTERPRISE

Provider Business Mailing Address
First Line	:	714 CROMPTON CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-1255
Country	:	US
Telephone Number	:	314-584-9754
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 WOODLAWN AVE
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-7646
Country	:	US
Telephone Number	:	636-206-2650
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MR. KENNETH ANTHONY BARRETT
Credential	:	MSW, LCSW
Telephone Number	:	636-206-2650

Provider Enumeration Date	:	04/15/2018
Last Update Date	:	04/15/2018

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Directions to “BARRETT ENTERPRISE ” Practice Location

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