Provider Demographics
NPI:1063755593
Name:BARISICH, GREGORY GEORGE (LCSW)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:GEORGE
Last Name:BARISICH
Suffix:
Gender:M
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:PO BOX 555191
Mailing Address - Street 2:NAVAL HOSPITAL CAMP PENDLETON
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:02055-5191
Mailing Address - Country:US
Mailing Address - Phone:760-725-0025
Mailing Address - Fax:
Practice Address - Street 1:BLDG H-100 SANTA MARGARITA ROAD
Practice Address - Street 2:NAVAL HOSPITAL, CAMP PENDLETON (N68094)
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-9151
Practice Address - Country:US
Practice Address - Phone:760-725-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA165001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical