Provider Demographics
NPI:1932407152
Name:BARTON, KEVAN ANTHONY (LICSW)
Entity type:Individual
Prefix:MR
First Name:KEVAN
Middle Name:ANTHONY
Last Name:BARTON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 NEWBURY ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2424
Mailing Address - Country:US
Mailing Address - Phone:617-970-0974
Mailing Address - Fax:
Practice Address - Street 1:268 NEWBURY ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2424
Practice Address - Country:US
Practice Address - Phone:617-970-0974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1144801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical