Provider Demographics
NPI:1033404298
Name:BARLETTA, KRISTEN L (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:L
Last Name:BARLETTA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WEBSTER ST
Mailing Address - Street 2:STE 8
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1227
Mailing Address - Country:US
Mailing Address - Phone:781-754-6545
Mailing Address - Fax:781-536-0016
Practice Address - Street 1:105 WEBSTER ST
Practice Address - Street 2:STE 8
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1227
Practice Address - Country:US
Practice Address - Phone:781-754-6545
Practice Address - Fax:781-536-0016
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2264507363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110090944AMedicaid
MA110090944AMedicaid