Provider Demographics
NPI:1306213442
Name:BARBAGALLO, CARRIE LYNN (LCSW, SOTP TRAINEE)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN
Last Name:BARBAGALLO
Suffix:
Gender:F
Credentials:LCSW, SOTP TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3914
Mailing Address - Country:US
Mailing Address - Phone:804-353-4461
Mailing Address - Fax:
Practice Address - Street 1:3900 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3914
Practice Address - Country:US
Practice Address - Phone:804-353-4461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945182Medicaid