Provider Demographics
NPI:1861765505
Name:RADEBAUGH, BARBARA HELENE (LMSW)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:HELENE
Last Name:RADEBAUGH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2714 UNION AVENUE EXT
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-4436
Mailing Address - Country:US
Mailing Address - Phone:901-320-6111
Mailing Address - Fax:
Practice Address - Street 1:2714 UNION AVENUE EXT
Practice Address - Street 2:SUITE 400
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-4436
Practice Address - Country:US
Practice Address - Phone:901-320-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN76161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical