MEDICARE: MS. LEVONDA BARNES ASB, MHS

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1306210711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LEVONDA BARNES ASB, MHS

Provider Business Mailing Address
First Line	:	119 N 63RD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-2202
Country	:	US
Telephone Number	:	267-469-3726
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 N 63RD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-2202
Country	:	US
Telephone Number	:	267-469-3726
Fax Number	:

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

Provider Enumeration Date	:	11/23/2015
Last Update Date	:	11/23/2015

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