Provider Demographics
NPI:1306060447
Name:BARRY, KIM M (MSW, LICSW, LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:M
Last Name:BARRY
Suffix:
Gender:F
Credentials:MSW, LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14117 RIVERBIRCH CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-9484
Mailing Address - Country:US
Mailing Address - Phone:240-280-2590
Mailing Address - Fax:240-280-2591
Practice Address - Street 1:6525 BELCREST RD
Practice Address - Street 2:408
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2003
Practice Address - Country:US
Practice Address - Phone:240-418-3398
Practice Address - Fax:240-280-2591
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD105171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical