Provider Demographics
NPI:1427284959
Name:BARROW-KAISER, BERJE ADELE (PHD, BCN, DPSC, HTC)
Entity type:Individual
Prefix:
First Name:BERJE
Middle Name:ADELE
Last Name:BARROW-KAISER
Suffix:
Gender:F
Credentials:PHD, BCN, DPSC, HTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 JUAN TABO BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1818
Mailing Address - Country:US
Mailing Address - Phone:505-715-3452
Mailing Address - Fax:505-214-5459
Practice Address - Street 1:2420 JUAN TABO BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1818
Practice Address - Country:US
Practice Address - Phone:505-715-3452
Practice Address - Fax:505-214-5459
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X, 175L00000X
NV#5363246ZE0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No175L00000XOther Service ProvidersHomeopath