Provider Demographics
NPI:1124526256
Name:BARRY, REBECCA (MA, BCBA, LPC)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:BARRY
Suffix:
Gender:F
Credentials:MA, BCBA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3531 N RACE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-4047
Mailing Address - Country:US
Mailing Address - Phone:240-994-2285
Mailing Address - Fax:
Practice Address - Street 1:600 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1702
Practice Address - Country:US
Practice Address - Phone:303-816-1916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-15-18309103K00000X
COLPC.0014231101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst