Provider Demographics
NPI:1497539720
Name:BARRIOS ROTTMANN, JUAN PABLO (LRC)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:PABLO
Last Name:BARRIOS ROTTMANN
Suffix:
Gender:M
Credentials:LRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 NEWBURY ST
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-2613
Mailing Address - Country:US
Mailing Address - Phone:703-674-8050
Mailing Address - Fax:
Practice Address - Street 1:148 NEWBURY ST
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-2613
Practice Address - Country:US
Practice Address - Phone:571-748-6887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016189101Y00000X
VA0701014983101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor