Provider Demographics
NPI:1144301771
Name:BARGE, RADINE (PHD)
Entity type:Individual
Prefix:
First Name:RADINE
Middle Name:
Last Name:BARGE
Suffix:
Gender:F
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:PO BOX 6884
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80934-6884
Mailing Address - Country:US
Mailing Address - Phone:719-597-8990
Mailing Address - Fax:719-597-3608
Practice Address - Street 1:3055 AUSTIN BLUFFS PKWY STE A
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5758
Practice Address - Country:US
Practice Address - Phone:719-597-8990
Practice Address - Fax:719-597-3608
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1166103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC6023-6Medicare ID - Type Unspecified