Provider Demographics
NPI:1922181254
Name:FORTUNATO, BARBARA J (RN, MS, NPP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:J
Last Name:FORTUNATO
Suffix:
Gender:F
Credentials:RN, MS, NPP
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:FORTUNATO HASTINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MS, NPP
Mailing Address - Street 1:55 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-1210
Mailing Address - Country:US
Mailing Address - Phone:607-595-1404
Mailing Address - Fax:607-772-2964
Practice Address - Street 1:2-8 HAWLEY ST.
Practice Address - Street 2:BERKSHIRE FARM CENTER FOR YOUTH
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-3114
Practice Address - Country:US
Practice Address - Phone:607-595-1404
Practice Address - Fax:607-772-2964
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400767363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health