Provider Demographics
NPI:1548725203
Name:BARNES, MARIO DESHAUN (MSW)
Entity type:Individual
Prefix:MR
First Name:MARIO
Middle Name:DESHAUN
Last Name:BARNES
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-3568
Mailing Address - Country:US
Mailing Address - Phone:757-240-7035
Mailing Address - Fax:
Practice Address - Street 1:1 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-3568
Practice Address - Country:US
Practice Address - Phone:757-240-7035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT28-42-8330Medicaid