Basic Information
Provider Information | |||||||||
NPI: | 1275095283 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BARTON | ||||||||
FirstName: | ALISA | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1115 WYNNMERE WALK AVE | ||||||||
Address2: |   | ||||||||
City: | RUSKIN | ||||||||
State: | FL | ||||||||
PostalCode: | 335702069 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7272256416 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 10000 BAY PINES BLVD | ||||||||
Address2: |   | ||||||||
City: | BAY PINES | ||||||||
State: | FL | ||||||||
PostalCode: | 337448200 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7273986661 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/01/2019 | ||||||||
LastUpdateDate: | 03/17/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/17/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW18153 | FL | N |   | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | 105331 | NY | Y |   | Behavioral Health & Social Service Providers | Social Worker |   |
No ID Information.