Provider Demographics
NPI:1124458781
Name:BAR-ON, SHIRA
Entity type:Individual
Prefix:
First Name:SHIRA
Middle Name:
Last Name:BAR-ON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 TRIBUTE CENTER DR
Mailing Address - Street 2:APT 441
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3214
Mailing Address - Country:US
Mailing Address - Phone:917-446-1113
Mailing Address - Fax:
Practice Address - Street 1:2216 S MIAMI BLVD STE 103
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-6284
Practice Address - Country:US
Practice Address - Phone:919-806-0509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0083261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP008326OtherLCSWA