Provider Demographics
NPI:1801813449
Name:KIRSHNER, BARRY JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:JAY
Last Name:KIRSHNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9033 GLADES RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3939
Mailing Address - Country:US
Mailing Address - Phone:561-361-0500
Mailing Address - Fax:561-479-0384
Practice Address - Street 1:9033 GLADES RD
Practice Address - Street 2:SUITE B
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3939
Practice Address - Country:US
Practice Address - Phone:561-361-0500
Practice Address - Fax:561-479-0384
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6158103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6415AMedicare ID - Type UnspecifiedMEDICARE NUMBER