Provider Demographics
NPI:1346626744
Name:PROSNIEWSKI, BARBARA ELIABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:ELIABETH
Last Name:PROSNIEWSKI
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 1:132 LELAND ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4030
Mailing Address - Country:US
Mailing Address - Phone:707-583-2363
Mailing Address - Fax:707-595-5385
Practice Address - Street 1:19378 PINE GLADE
Practice Address - Street 2:
Practice Address - City:GUERNEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95446-9046
Practice Address - Country:US
Practice Address - Phone:707-865-5154
Practice Address - Fax:707-865-5154
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17496103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist