MEDICARE: TINA LANIER BARRETT MA

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	103T00000X	Psychologist	1768	NC
2	103TB0200X	Cognitive & Behavioral Psychologist	1768	NC
3	103TH0100X	Health Service Psychologist	1768	NC
4	103TM1800X	Intellectual & Developmental Disabilities Psychologist	1768	NC

General Provider Information

NPI Number	:	1619145257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA LANIER BARRETT MA

Provider Business Mailing Address
First Line	:	9830 WYNGATE RIDGE DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-4796
Country	:	US
Telephone Number	:	919-400-8493
Fax Number	:

Provider Business Practice Location Address
First Line	:	2031 MARTIN LUTHER KING JR DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-3342
Country	:	US
Telephone Number	:	919-632-7641
Fax Number	:

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

Provider Enumeration Date	:	02/18/2008
Last Update Date	:	08/16/2019

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