Basic Information
| Provider Information | |||||||||
| NPI: | 1124458781 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAR-ON | ||||||||
| FirstName: | SHIRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 TRIBUTE CENTER DR | ||||||||
| Address2: | APT 441 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276123214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9174461113 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2216 S MIAMI BLVD STE 103 | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277036284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198060509 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2013 | ||||||||
| LastUpdateDate: | 11/19/2013 | ||||||||
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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 | 1041C0700X | P008326 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | P008326 | 01 | NC | LCSWA | OTHER |