Provider Demographics
NPI:1386010072
Name:MCCLAIN, BARAK SR
Entity type:Individual
Prefix:MR
First Name:BARAK
Middle Name:
Last Name:MCCLAIN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2152 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-4647
Mailing Address - Country:US
Mailing Address - Phone:772-567-5142
Mailing Address - Fax:772-567-5178
Practice Address - Street 1:2152 58TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-4647
Practice Address - Country:US
Practice Address - Phone:772-567-5142
Practice Address - Fax:772-567-5178
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4305237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist