Provider Demographics
NPI:1669027496
Name:BARDO-BARNES, LISA
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:BARDO-BARNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PICKER RD
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-1252
Mailing Address - Country:US
Mailing Address - Phone:508-784-6447
Mailing Address - Fax:
Practice Address - Street 1:1 PICKER RD
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1252
Practice Address - Country:US
Practice Address - Phone:508-784-6447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health