Provider Demographics
NPI:1972986750
Name:BARCENAS, CALEB
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:BARCENAS
Suffix:
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 1:240 W THOMAS RD # 301
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4407
Mailing Address - Country:US
Mailing Address - Phone:602-406-6238
Mailing Address - Fax:602-230-4089
Practice Address - Street 1:222 W THOMAS RD STE 401
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4423
Practice Address - Country:US
Practice Address - Phone:602-406-3473
Practice Address - Fax:602-406-4406
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005802103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist