Provider Demographics
NPI:1033845425
Name:BARBERIS, PATRICIA JEANNE
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JEANNE
Last Name:BARBERIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PATRICIA
Mailing Address - Street 1:651 STRANDER BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2914
Mailing Address - Country:US
Mailing Address - Phone:206-313-8840
Mailing Address - Fax:
Practice Address - Street 1:9330 59TH AVE SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2858
Practice Address - Country:US
Practice Address - Phone:253-581-7020
Practice Address - Fax:253-620-5140
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA111524501Medicaid