Provider Demographics
NPI:1326193798
Name:BARRENTINE, FAITH N (PHD)
Entity Type:Individual
Prefix:DR
First Name:FAITH
Middle Name:N
Last Name:BARRENTINE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:FAITH
Other - Middle Name:N
Other - Last Name:BARRENTINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:28 N COUNTRY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-1518
Mailing Address - Country:US
Mailing Address - Phone:631-928-4506
Mailing Address - Fax:631-828-6106
Practice Address - Street 1:28 N COUNTRY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766-1518
Practice Address - Country:US
Practice Address - Phone:631-928-4506
Practice Address - Fax:631-828-6106
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128733103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV2B391Medicare ID - Type Unspecified