Provider Demographics
NPI:1235163130
Name:BARKLEY, THOMAS J (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:BARKLEY
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 1:120 WEST AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-6076
Mailing Address - Country:US
Mailing Address - Phone:518-584-8051
Mailing Address - Fax:518-584-2523
Practice Address - Street 1:120 WEST AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-6076
Practice Address - Country:US
Practice Address - Phone:518-584-8051
Practice Address - Fax:518-584-2523
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011141103TB0200X, 103TC0700X, 103TA0400X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6894248OtherGHI MCO PIN
NY131773OtherVO MCO PIN
NY10022509OtherCDPHP HMO PIN
NY41386OtherMVP HMO PIN
NY011141OtherLICENSE NUMBER
NY131773OtherVO MCO PIN