Provider Demographics
NPI:1447319850
Name:THEODORO, BARBARA JEAN (LSW)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:THEODORO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:JEAN
Other - Last Name:MINGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1203 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155-2117
Mailing Address - Country:US
Mailing Address - Phone:304-771-2089
Mailing Address - Fax:304-234-3511
Practice Address - Street 1:307 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-1215
Practice Address - Country:US
Practice Address - Phone:304-455-3622
Practice Address - Fax:304-234-3511
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00941142104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001719068OtherBCBS