Provider Demographics
NPI:1477621944
Name:FEDERMAN, BARRY H (RN,MS,CNS)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:H
Last Name:FEDERMAN
Suffix:
Gender:M
Credentials:RN,MS,CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 TRUMBULL RD
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3036
Mailing Address - Country:US
Mailing Address - Phone:413-584-4600
Mailing Address - Fax:413-584-5200
Practice Address - Street 1:9 CENTER CT # 5
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-584-4600
Practice Address - Fax:413-584-5200
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA184485364SP0809X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral