Provider Demographics
NPI:1760995336
Name:PISHA, BARTON
Entity Type:Individual
Prefix:
First Name:BARTON
Middle Name:
Last Name:PISHA
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 1:254 BROOKLINE ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4518
Mailing Address - Country:US
Mailing Address - Phone:617-290-7070
Mailing Address - Fax:
Practice Address - Street 1:254 BROOKLINE ST UNIT 1
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4518
Practice Address - Country:US
Practice Address - Phone:617-290-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician