Provider Demographics
NPI:1194874008
Name:ERDMAN, BARRY (LCSW, DCSW)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:
Last Name:ERDMAN
Suffix:
Gender:M
Credentials:LCSW, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 PENROSE PL
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1828
Mailing Address - Country:US
Mailing Address - Phone:303-444-1404
Mailing Address - Fax:303-444-3491
Practice Address - Street 1:3450 PENROSE PL
Practice Address - Street 2:SUITE 210
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1828
Practice Address - Country:US
Practice Address - Phone:303-444-1404
Practice Address - Fax:303-444-3491
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9890181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO477448Medicare PIN
COR20117Medicare UPIN
CO477458Medicare PIN