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NPI Code Detail

MEDICARE: MS. ROBERTA SUE BARRY LCSW

MEDICARE:  MS. ROBERTA SUE BARRY  LCSW
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
11041C0700XClinical Social WorkerIL

General Provider Information

NPI Number : 1578560736
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ROBERTA SUE BARRY LCSW
Provider Business Mailing Address
First Line : 2324 CENTRAL ST
Second Line : APT. 4B
City : EVANSTON
State : IL
Zip : 60201-5700
Country : US
Telephone Number : 847-869-3105
Fax Number :
Provider Business Practice Location Address
First Line : 4753 N BROADWAY ST
Second Line : SUITE 928
City : CHICAGO
State : IL
Zip : 60640-5266
Country : US
Telephone Number : 847-869-3105
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2005
Last Update Date : 07/08/2007

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Directions to “ MS. ROBERTA SUE BARRY LCSW” Practice Location

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