Provider Demographics
NPI:1336271022
Name:NYMAN, BARRY A (PHD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:A
Last Name:NYMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1044
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-1044
Mailing Address - Country:US
Mailing Address - Phone:425-252-6529
Mailing Address - Fax:425-252-9235
Practice Address - Street 1:3728 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4678
Practice Address - Country:US
Practice Address - Phone:425-252-6529
Practice Address - Fax:425-252-9235
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY0000000230103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7066897Medicaid
R31781Medicare UPIN
G8801936Medicare ID - Type Unspecified