Basic Information
| Provider Information | |||||||||
| NPI: | 1255519765 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARRY | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 E 10TH ST | ||||||||
| Address2: | APT#4 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908134715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622537264 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1078 ATLANTIC AVE | ||||||||
| Address2: | WELNESS CENTER | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622850149 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2008 | ||||||||
| LastUpdateDate: | 02/06/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | NA | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.