MEDICARE: JENNIFER JEAN BARRY LCSW, CCM

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	171M00000X	Case Manager/Care Coordinator	4214625
2	1041C0700X	Clinical Social Worker	67264	TX

General Provider Information

NPI Number	:	1366048415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER JEAN BARRY LCSW, CCM

Provider Business Mailing Address
First Line	:	777 LAKE CAROLYN PKWY APT 4103
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-4514
Country	:	US
Telephone Number	:	443-226-7338
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 LAKE CAROLYN PKWY APT 4103
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-4514
Country	:	US
Telephone Number	:	443-226-7338
Fax Number	:

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

Provider Enumeration Date	:	12/04/2020
Last Update Date	:	12/04/2020

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