Provider Demographics
NPI:1154781888
Name:BARTON, JOAN
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:BARTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JOAN
Other - Middle Name:W
Other - Last Name:BARTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MENTAL HEALTH COUNSE
Mailing Address - Street 1:3928 TANGLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-3525
Mailing Address - Country:US
Mailing Address - Phone:321-432-9716
Mailing Address - Fax:
Practice Address - Street 1:3157 N ALAFAYA TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-2940
Practice Address - Country:US
Practice Address - Phone:407-215-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 14030171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator