Provider Demographics
NPI:1447853205
Name:BARRETT, KARRA
Entity type:Individual
Prefix:
First Name:KARRA
Middle Name:
Last Name:BARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 ELECTRIC AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-2600
Mailing Address - Country:US
Mailing Address - Phone:716-983-2207
Mailing Address - Fax:
Practice Address - Street 1:1534 ELECTRIC AVE APT 1
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-2600
Practice Address - Country:US
Practice Address - Phone:716-983-2207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCARC-5235171400000X
NYCRPA-P-6212175T00000X
NYNYCPSP-4139175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171400000XOther Service ProvidersHealth & Wellness Coach