Provider Demographics
NPI:1750313185
Name:BARBATO, MARY C (CNS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:BARBATO
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:DONNELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNS
Mailing Address - Street 1:50 STOW ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-1613
Mailing Address - Country:US
Mailing Address - Phone:508-790-1925
Mailing Address - Fax:508-790-1925
Practice Address - Street 1:103 MYRON ST
Practice Address - Street 2:SUITE A
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1598
Practice Address - Country:US
Practice Address - Phone:413-592-1980
Practice Address - Fax:413-439-0096
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150905364SG0600X
MARN150905364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA890000431OtherRAIL ROAD MEDICARE
MA83-00774OtherEVERCARE
MANS0312Medicare ID - Type Unspecified
MA83-00774OtherEVERCARE