Provider Demographics
NPI:1235408972
Name:BARMAK, SHANT ARI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHANT
Middle Name:ARI
Last Name:BARMAK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3790 VIA DE LA VALLE STE 104E
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-4248
Mailing Address - Country:US
Mailing Address - Phone:858-220-8526
Mailing Address - Fax:
Practice Address - Street 1:3790 VIA DE LA VALLE STE 104E
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-4248
Practice Address - Country:US
Practice Address - Phone:858-220-8526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 24998103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical