Provider Demographics
NPI:1497585715
Name:BARCLAY, KOLLEEN
Entity type:Individual
Prefix:
First Name:KOLLEEN
Middle Name:
Last Name:BARCLAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5517 VOLTA AVE
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1555
Mailing Address - Country:US
Mailing Address - Phone:301-367-8360
Mailing Address - Fax:
Practice Address - Street 1:5517 VOLTA AVE
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1555
Practice Address - Country:US
Practice Address - Phone:301-367-8360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool