Provider Demographics
NPI:1861827420
Name:BARRY, JOSHUA LEE (LICSW)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:LEE
Last Name:BARRY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 ARNOLD DR STE 404
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK AIR FORCE BASE
Mailing Address - State:AR
Mailing Address - Zip Code:72099-4927
Mailing Address - Country:US
Mailing Address - Phone:405-517-3723
Mailing Address - Fax:
Practice Address - Street 1:940 ARNOLD DR STE 404
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK AIR FORCE BASE
Practice Address - State:AR
Practice Address - Zip Code:72099-4927
Practice Address - Country:US
Practice Address - Phone:405-517-3723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01022661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT089.01020266OtherSTATE