Provider Demographics
NPI:1073715611
Name:BARABAS, DUSTAN ALLEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DUSTAN
Middle Name:ALLEN
Last Name:BARABAS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:DUSTAN
Other - Middle Name:A
Other - Last Name:BARABAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:TANNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18372-0204
Mailing Address - Country:US
Mailing Address - Phone:570-629-4900
Mailing Address - Fax:570-688-9890
Practice Address - Street 1:930 N 9TH ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360
Practice Address - Country:US
Practice Address - Phone:570-629-4900
Practice Address - Fax:570-420-1248
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016559103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001965985Medicaid