Provider Demographics
NPI:1679871032
Name:BARRON, BERNADETTE (NP)
Entity Type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:
Last Name:BARRON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-6066
Mailing Address - Country:US
Mailing Address - Phone:631-471-7242
Mailing Address - Fax:631-471-5150
Practice Address - Street 1:1 CRESTHILL PL
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3703
Practice Address - Country:US
Practice Address - Phone:631-764-7133
Practice Address - Fax:631-242-4108
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401368-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health