Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PS005226L | PA |
N | 103T00000X | Psychologist | PS005226L | PA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PS005226L | PA |
Y | 103G00000X | Clinical Psychologist | PS005226L | PA |
Y | 103TC0700X | Clinical Psychologist | PS005226L | PA |
N | 103TP2701X | Group Psychotherapist | PS005226L | PA |
NPI | 1013932037 |
---|---|
Provider Name | Jacques P Barber |
First Address | Philadelphia, PA 19104-3309 |
Second Address | Philadelphia, PA 19104-3309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 02/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R05918 | (02) | PA |