MEDICARE: DANIELLE BARNES

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	103TF0200X	Forensic Psychologist	PSY1715	NM
2	103TC0700X	Clinical Psychologist	PSY1715	NM

General Provider Information

NPI Number	:	1629524285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE BARNES

Provider Business Mailing Address
First Line	:	2500 SAWMILL RD APT 915
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-5689
Country	:	US
Telephone Number	:	818-618-9501
Fax Number	:

Provider Business Practice Location Address
First Line	:	3685 HOT SPRINGS BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701
Country	:	US
Telephone Number	:	505-454-2644
Fax Number	:

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

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	03/03/2022

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Directions to “ DANIELLE BARNES ” Practice Location

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