Provider Demographics
NPI:1215039904
Name:FONTANA, BARBARA (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:
Last Name:FONTANA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 ROUTE 25A
Mailing Address - Street 2:STE A2
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786-1389
Mailing Address - Country:US
Mailing Address - Phone:631-821-1880
Mailing Address - Fax:631-821-4750
Practice Address - Street 1:45 ROUTE 25A
Practice Address - Street 2:STE A2
Practice Address - City:SHOREHAM
Practice Address - State:NY
Practice Address - Zip Code:11786-1389
Practice Address - Country:US
Practice Address - Phone:631-821-1880
Practice Address - Fax:631-821-4750
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5854103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV12931Medicare UPIN