Provider Demographics
NPI:1275713877
Name:BARRY, JACQUELINE ALFONSO (MS)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ALFONSO
Last Name:BARRY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 QUINSHIPAUG RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1175
Mailing Address - Country:US
Mailing Address - Phone:305-216-8008
Mailing Address - Fax:617-812-2448
Practice Address - Street 1:264 BEACON ST FL 6
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116
Practice Address - Country:US
Practice Address - Phone:617-431-3749
Practice Address - Fax:617-812-2448
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10075103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA10075OtherSTATE OF MASSACHUSETTS