Provider Demographics
NPI:1194972786
Name:BARICKMAN, A MACKENZIE (PSY D)
Entity type:Individual
Prefix:
First Name:A
Middle Name:MACKENZIE
Last Name:BARICKMAN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1479 W QUAIL RUN DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9276
Mailing Address - Country:US
Mailing Address - Phone:740-973-3774
Mailing Address - Fax:877-850-4646
Practice Address - Street 1:4985 SEARLS DR NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7464
Practice Address - Country:US
Practice Address - Phone:740-345-9197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6413103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical