Provider Demographics
NPI:1689359143
Name:BARISH, JEREMY FRANCIS
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:FRANCIS
Last Name:BARISH
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 1:378 NORTHLAKE BLVD # 145
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-5421
Mailing Address - Country:US
Mailing Address - Phone:305-497-6108
Mailing Address - Fax:
Practice Address - Street 1:420 S STATE ROAD 7 STE 174
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33414-4306
Practice Address - Country:US
Practice Address - Phone:561-568-9367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician