Provider Demographics
NPI:1710079033
Name:STUBENHAUS, BARBARA C (CNS (RN, MS, CS))
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:C
Last Name:STUBENHAUS
Suffix:
Gender:F
Credentials:CNS (RN, MS, CS)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 DUNDEE PARK,
Mailing Address - Street 2:SUITE B05
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810
Mailing Address - Country:US
Mailing Address - Phone:987-475-6622
Mailing Address - Fax:978-475-8436
Practice Address - Street 1:3 DUNDEE PARK.
Practice Address - Street 2:SUITE B05
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810
Practice Address - Country:US
Practice Address - Phone:987-475-6622
Practice Address - Fax:978-475-8436
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA96676364SP0808X
MARN96676364S00000X, 364SP0809X, 363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1897985Medicaid
MA1897985Medicaid
MAPN0292Medicare PIN