Provider Demographics
NPI:1205467727
Name:BARNETT, MARY C (BCBA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:BARNETT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:BARNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:275 CASCADE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-3819
Mailing Address - Country:US
Mailing Address - Phone:631-678-2490
Mailing Address - Fax:
Practice Address - Street 1:30 OLD BUDD LAKE RD
Practice Address - Street 2:
Practice Address - City:BUDD LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07828-1804
Practice Address - Country:US
Practice Address - Phone:845-987-4022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst