Provider Demographics
NPI:1730833484
Name:BARAHONA, IRIS (LICSW, LICSW-C)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:BARAHONA
Suffix:
Gender:F
Credentials:LICSW, LICSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12318 KEMMERTON LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-2721
Mailing Address - Country:US
Mailing Address - Phone:301-526-5037
Mailing Address - Fax:
Practice Address - Street 1:12318 KEMMERTON LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-2721
Practice Address - Country:US
Practice Address - Phone:301-526-5037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500806061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty