Provider Demographics
NPI:1841757614
Name:BARNES-PALTY, MARY PAMELA (PSYD)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:PAMELA
Last Name:BARNES-PALTY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11011 S 48TH STREET
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044
Mailing Address - Country:US
Mailing Address - Phone:303-594-2882
Mailing Address - Fax:
Practice Address - Street 1:11011 S 48TH STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044
Practice Address - Country:US
Practice Address - Phone:303-594-2882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005015103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical