Detella Ricketta Barron, MSW,LCSW
Individual provider Active NPI Clinical Social Worker · Braxton, MS
NPI 1104712298 · NPPES record last updated Jun 16, 2025
Key facts
- NPI
- 1104712298
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- CSW04072 (RI)
- Practice address
- 116 Allen Holmes Rd
Braxton, MS 39044-9549 - Phone
- (601) 382-4171
- NPI assigned
- Jun 16, 2025
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CSW04072 | RI | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | CSW04072 | RI | Yes |
Addresses
Primary practice location
116 Allen Holmes Rd
Braxton, MS 39044-9549
Mailing address
116 Allen Holmes Rd
Braxton, MS 39044-9549
Phone (601) 382-4171
Other providers in Braxton, MS
All providers in Braxton, MS · Clinical Social Worker in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.