Provider Demographics
NPI:1023032117
Name:BARBERA, ELEANOR (PHD)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:BARBERA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 79TH ST
Mailing Address - Street 2:#3A
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-2607
Mailing Address - Country:US
Mailing Address - Phone:646-322-2885
Mailing Address - Fax:
Practice Address - Street 1:3420 79TH ST
Practice Address - Street 2:APT 3A
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-2601
Practice Address - Country:US
Practice Address - Phone:212-851-8100
Practice Address - Fax:889-772-5478
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10963103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02856OtherGHI MEDICARE
NY01653185Medicaid
NYV17131Medicare PIN