Provider Demographics
NPI:1346686110
Name:BARSAMIAN, JACQUE ERNIE
Entity Type:Individual
Prefix:
First Name:JACQUE
Middle Name:ERNIE
Last Name:BARSAMIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:893 S FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-6512
Mailing Address - Country:US
Mailing Address - Phone:559-348-9789
Mailing Address - Fax:
Practice Address - Street 1:885 W 18TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-4604
Practice Address - Country:US
Practice Address - Phone:209-726-3090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports