Provider Demographics
NPI:1356453070
Name:NIGROSH, BARRY J (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:J
Last Name:NIGROSH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-6460
Mailing Address - Country:US
Mailing Address - Phone:413-539-9731
Mailing Address - Fax:413-538-6116
Practice Address - Street 1:25 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-6460
Practice Address - Country:US
Practice Address - Phone:413-539-9731
Practice Address - Fax:413-538-6116
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPY 1900 PR103TC0700X, 103TF0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW02404Medicare ID - Type Unspecified