Provider Demographics
NPI:1447744313
Name:BARRY, CATHERINE (IBCLC, RD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:BARRY
Suffix:
Gender:F
Credentials:IBCLC, RD
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:FANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:128 MAGAZINE ST APT 16
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3920
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:438 MAIN ST
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3810
Practice Address - Country:US
Practice Address - Phone:978-621-4408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2023-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA86010485133V00000X
MAL-310853174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty