Provider Demographics
NPI:1417419060
Name:BARNES, JOHN BENJAMIN (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BENJAMIN
Last Name:BARNES
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 1:6 STUBTOE LN
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-1658
Mailing Address - Country:US
Mailing Address - Phone:781-413-1215
Mailing Address - Fax:
Practice Address - Street 1:6 STUBTOE LN
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-1658
Practice Address - Country:US
Practice Address - Phone:781-413-1215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11044OtherSTATE LICENSE