Provider Demographics
NPI:1891434502
Name:BARRIOS, FALLON
Entity Type:Individual
Prefix:
First Name:FALLON
Middle Name:
Last Name:BARRIOS
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 1:311 BOULEVARD OF AMERICAS STE 304
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4788
Mailing Address - Country:US
Mailing Address - Phone:402-252-1363
Mailing Address - Fax:
Practice Address - Street 1:3348 PEACHTREE RD NE STE 700
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1682
Practice Address - Country:US
Practice Address - Phone:732-806-0091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1-22-58060103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst