Provider Demographics
NPI:1073296083
Name:BARBOZA, TROY TYLER
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:TYLER
Last Name:BARBOZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 LAPHAM ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-3732
Mailing Address - Country:US
Mailing Address - Phone:774-488-6342
Mailing Address - Fax:
Practice Address - Street 1:4A COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1598
Practice Address - Country:US
Practice Address - Phone:508-807-4997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALABA10000314103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst