Provider Demographics
NPI:1609358613
Name:LABARBARA, EDMUND JAMES (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:JAMES
Last Name:LABARBARA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3023
Mailing Address - Country:US
Mailing Address - Phone:412-580-1280
Mailing Address - Fax:
Practice Address - Street 1:1130 SW MORRISON ST STE 619
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2217
Practice Address - Country:US
Practice Address - Phone:971-910-4105
Practice Address - Fax:503-208-3085
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3315103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist