Provider Demographics
NPI:1285726455
Name:BARNES, PEGGY ALENE (LMSW)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:ALENE
Last Name:BARNES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48826-0223
Mailing Address - Country:US
Mailing Address - Phone:517-485-7572
Mailing Address - Fax:
Practice Address - Street 1:1140 ABBOT RD
Practice Address - Street 2:#223
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-0223
Practice Address - Country:US
Practice Address - Phone:517-485-7572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010599541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM39820Medicare ID - Type Unspecified
MIS40952Medicare UPIN