Provider Demographics
NPI:1013631431
Name:BARRY, CHRISTINE A
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINE
Middle Name:A
Last Name:BARRY
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 1:5316 WITCH HAZEL LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-4905
Mailing Address - Country:US
Mailing Address - Phone:240-678-4418
Mailing Address - Fax:
Practice Address - Street 1:5316 WITCH HAZEL LN
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-4905
Practice Address - Country:US
Practice Address - Phone:240-678-4418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13144101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health