Provider Demographics
NPI:1306923289
Name:SHORT, BARBARA CLAIRE (LCSW-R)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:CLAIRE
Last Name:SHORT
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7634 CAMPBELL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-7612
Mailing Address - Country:US
Mailing Address - Phone:607-776-4151
Mailing Address - Fax:
Practice Address - Street 1:7634 CAMPBELL CREEK RD
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-7612
Practice Address - Country:US
Practice Address - Phone:607-776-4151
Practice Address - Fax:607-776-6929
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0455121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00045512Medicaid
NY00045512Medicaid