Provider Demographics
NPI:1689715815
Name:BARRY, COLEEN (PHD, LCMHC)
Entity Type:Individual
Prefix:DR
First Name:COLEEN
Middle Name:
Last Name:BARRY
Suffix:
Gender:F
Credentials:PHD, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 JENKINS COURT
Mailing Address - Street 2:STE 200, BOX 10
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-2324
Mailing Address - Country:US
Mailing Address - Phone:603-617-2988
Mailing Address - Fax:844-289-6799
Practice Address - Street 1:13 JENKINS CT STE 200
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-2324
Practice Address - Country:US
Practice Address - Phone:603-617-2988
Practice Address - Fax:844-289-6799
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2220002001OtherBCBS SUBSTANCE ABUSE
MAM18684OtherBCBS MENTAL HEALTH
MA1306421Medicaid
MA1308785Medicaid
MA1306421Medicaid