Provider Demographics
NPI:1902115660
Name:BREWER, BARRY DOMINIC (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:DOMINIC
Last Name:BREWER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 AYLESWORTH NW
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80523-8010
Mailing Address - Country:US
Mailing Address - Phone:970-491-5780
Mailing Address - Fax:970-491-2582
Practice Address - Street 1:123 AYLESWORTH NW
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80523-8010
Practice Address - Country:US
Practice Address - Phone:970-491-5780
Practice Address - Fax:970-491-2582
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9917541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical