Individual
MR. BARRY MICHAEL WIDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISW
Contact information
Practice address
4100 W 3RD ST, DAYTON, OH 45428-9000
(937) 268-6511
(937) 267-3924
Mailing address
4100 W 3RD ST, DAYTON, OH 45428-9000
(937) 268-6511
(937) 267-3924
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
954293
OH
1041C0700X
Clinical Social Worker
Primary
I0800083
OH
Other
Enumeration date
11/12/2008
Last updated
02/24/2020
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