Provider Demographics
NPI:1760758072
Name:BARNES, NICOLE SABRINA
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:SABRINA
Last Name:BARNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 STATON STREET
Mailing Address - Street 2:2L
Mailing Address - City:DORCHESTER-CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124
Mailing Address - Country:US
Mailing Address - Phone:508-617-0060
Mailing Address - Fax:
Practice Address - Street 1:38 STANTON ST
Practice Address - Street 2:2L
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-4346
Practice Address - Country:US
Practice Address - Phone:508-617-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor