MEDICARE: PEGGY ALENE BARNES L.M.S.W.

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	6801059954	MI

General Provider Information

NPI Number	:	1285726455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEGGY ALENE BARNES L.M.S.W.

Provider Business Mailing Address
First Line	:	PO BOX 223
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48826-0223
Country	:	US
Telephone Number	:	517-485-7572
Fax Number	:

Provider Business Practice Location Address
First Line	:	1140 ABBOT RD
Second Line	:	#223
City	:	EAST LANSING
State	:	MI
Zip	:	48823-0223
Country	:	US
Telephone Number	:	517-485-7572
Fax Number	:

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	12/06/2021

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