Provider Demographics
NPI:1093755928
Name:PLATT, BARRY B (PHD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:B
Last Name:PLATT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3130
Mailing Address - Country:US
Mailing Address - Phone:585-461-2017
Mailing Address - Fax:
Practice Address - Street 1:1 LAKEVIEW PARK
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14613-1708
Practice Address - Country:US
Practice Address - Phone:585-647-6414
Practice Address - Fax:585-458-3477
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2010-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0063971103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
16716BMedicare ID - Type Unspecified