Provider Demographics
NPI:1871962506
Name:BARNES, WILLIAM KPANAH GOWAH (LBSC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:KPANAH GOWAH
Last Name:BARNES
Suffix:
Gender:M
Credentials:LBSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9229 BLUE GRASS RD
Mailing Address - Street 2:APT 1
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-4375
Mailing Address - Country:US
Mailing Address - Phone:267-777-2631
Mailing Address - Fax:
Practice Address - Street 1:9229 BLUE GRASS RD
Practice Address - Street 2:APT 1
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-4375
Practice Address - Country:US
Practice Address - Phone:267-777-2631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002703103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst