Provider Demographics
NPI:1629135918
Name:BARNEY, GORDON LOUIS
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:LOUIS
Last Name:BARNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:PROVINCETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02657-1316
Mailing Address - Country:US
Mailing Address - Phone:508-487-9009
Mailing Address - Fax:
Practice Address - Street 1:180 BRACKETT RD
Practice Address - Street 2:
Practice Address - City:EASTHAM
Practice Address - State:MA
Practice Address - Zip Code:02642-2703
Practice Address - Country:US
Practice Address - Phone:508-240-7861
Practice Address - Fax:508-240-7861
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5337101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health