Provider Demographics
NPI:1285142679
Name:BARTH, LYSSA (LICSW)
Entity type:Individual
Prefix:
First Name:LYSSA
Middle Name:
Last Name:BARTH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 L ST NW STE 100-511
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-4018
Mailing Address - Country:US
Mailing Address - Phone:202-270-0502
Mailing Address - Fax:
Practice Address - Street 1:1220 L ST NW STE 100-511
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-4018
Practice Address - Country:US
Practice Address - Phone:202-270-0502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150101636104100000X
DCLC500819491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker