Provider Demographics
NPI:1073807640
Name:COBB, BARRY E (MA)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:E
Last Name:COBB
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 GATEWAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1893
Mailing Address - Country:US
Mailing Address - Phone:513-234-7870
Mailing Address - Fax:513-234-7836
Practice Address - Street 1:9881 BOLINGBROKE DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45241-3680
Practice Address - Country:US
Practice Address - Phone:513-703-4638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1426103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist