Provider Demographics
NPI:1770744088
Name:BARDEN, JAMES S (LCSW-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:S
Last Name:BARDEN
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:PETE
Other - Middle Name:
Other - Last Name:BARDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:107 RIDGELY AVE STE 13B
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1417
Mailing Address - Country:US
Mailing Address - Phone:410-268-8188
Mailing Address - Fax:410-268-0619
Practice Address - Street 1:107 RIDGELY AVE STE 13B
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1417
Practice Address - Country:US
Practice Address - Phone:410-268-8188
Practice Address - Fax:410-268-0619
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD059861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD521190421OtherTAX ID NUMBER