Provider Demographics
NPI:1548592173
Name:BARRY, LISA ANN (RNC; MSW; PMHNP-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:BARRY
Suffix:
Gender:F
Credentials:RNC; MSW; PMHNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7060
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04070-7060
Mailing Address - Country:US
Mailing Address - Phone:207-799-9888
Mailing Address - Fax:207-799-9887
Practice Address - Street 1:15 PLEASANT HILL RD STE 204
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9688
Practice Address - Country:US
Practice Address - Phone:207-799-9888
Practice Address - Fax:207-799-9887
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN25117163W00000X
MECNP91065363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME435421999Medicaid
MEE400247493Medicare PIN
MEE400247599Medicare PIN
MEE400247537Medicare PIN
ME435421999Medicaid