Provider Demographics
NPI:1780984609
Name:REDFORD, BARRY R (LCSW)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:R
Last Name:REDFORD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 NORTH 7TH
Mailing Address - Street 2:STE #F
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201
Mailing Address - Country:US
Mailing Address - Phone:208-424-3044
Mailing Address - Fax:208-904-0494
Practice Address - Street 1:707 NORTH 7TH
Practice Address - Street 2:STE #F
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:208-424-3044
Practice Address - Fax:208-904-0494
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-26140104100000X
IDLCSW-35197104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker