Provider Demographics
NPI:1063895878
Name:BARRY, LORRAINE (LMFT)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:BARRY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4183 BAY BEACH LN APT 365
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33931-6918
Mailing Address - Country:US
Mailing Address - Phone:732-915-3624
Mailing Address - Fax:
Practice Address - Street 1:4183 BAY BEACH LN APT 365
Practice Address - Street 2:
Practice Address - City:FORT MYERS BEACH
Practice Address - State:FL
Practice Address - Zip Code:33931-6918
Practice Address - Country:US
Practice Address - Phone:732-915-3624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001549106H00000X
PAMF001181106H00000X
NJ37FI001437106H00000X
106H00000X
NJ37LC00240200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist