Provider Demographics
NPI:1194739722
Name:WISEMAN, BARBARA (MSW)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2530
Mailing Address - Country:US
Mailing Address - Phone:626-450-9414
Mailing Address - Fax:626-577-9069
Practice Address - Street 1:722 FREMONT AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2530
Practice Address - Country:US
Practice Address - Phone:626-450-9414
Practice Address - Fax:626-577-9069
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALJ10623101YM0800X
CA106231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW10623Medicare ID - Type Unspecified