Provider Demographics
NPI:1356815237
Name:BARZ, ELLEN MAE
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MAE
Last Name:BARZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CROSBY ST APT 2N
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3254
Mailing Address - Country:US
Mailing Address - Phone:212-925-1062
Mailing Address - Fax:
Practice Address - Street 1:39 CROSBY ST APT 2N
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3254
Practice Address - Country:US
Practice Address - Phone:212-925-1062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000114102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty