Provider Demographics
NPI:1033317698
Name:BARRY, JENNIFER LYNN (MS,CRC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:BARRY
Suffix:
Gender:F
Credentials:MS,CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:80 GOODRICH ST
Mailing Address - Street 2:ADDICTION CLINIC
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1005
Mailing Address - Country:US
Mailing Address - Phone:716-859-3726
Mailing Address - Fax:716-859-2434
Practice Address - Street 1:80 GOODRICH ST
Practice Address - Street 2:ADDICTION CLINIC
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1005
Practice Address - Country:US
Practice Address - Phone:716-859-3726
Practice Address - Fax:716-859-2434
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12046101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)