Provider Demographics
NPI:1043633944
Name:BARRETT, MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:BARRETT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:NICOLE
Other - Last Name:BRYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:633 MDOS/SGOW
Mailing Address - Street 2:77 NEALY AVE.
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23665
Mailing Address - Country:US
Mailing Address - Phone:757-764-6840
Mailing Address - Fax:
Practice Address - Street 1:39 ASH AVE BLDG 289
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23665-2011
Practice Address - Country:US
Practice Address - Phone:757-764-6840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004864103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical