Provider Demographics
NPI:1316481740
Name:BARBARA GHEN PLLC
Entity type:Organization
Organization Name:BARBARA GHEN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-592-7740
Mailing Address - Street 1:12128 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5575
Mailing Address - Country:US
Mailing Address - Phone:352-592-7740
Mailing Address - Fax:352-592-7742
Practice Address - Street 1:12128 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5575
Practice Address - Country:US
Practice Address - Phone:352-592-7740
Practice Address - Fax:352-592-7742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-04
Last Update Date:2016-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5962261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ0426Medicare PIN