Provider Demographics
NPI:1053671602
Name:HARRIS, BARBARA ANNA (LCSW)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANNA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 DEERSPRING PL
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-5504
Mailing Address - Country:US
Mailing Address - Phone:805-551-8257
Mailing Address - Fax:
Practice Address - Street 1:923 DEERSPRING PL
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-5504
Practice Address - Country:US
Practice Address - Phone:805-551-8257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA196881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCSW19688OtherCALIFORNIA STATE LICENSE