Provider Demographics
NPI:1356538847
Name:BARSUKOV, SERGIY (PSYD)
Entity type:Individual
Prefix:DR
First Name:SERGIY
Middle Name:
Last Name:BARSUKOV
Suffix:
Gender:M
Credentials:PSYD
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 256
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-0256
Mailing Address - Country:US
Mailing Address - Phone:503-949-4961
Mailing Address - Fax:
Practice Address - Street 1:502 S SAINT PAUL HWY
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-7059
Practice Address - Country:US
Practice Address - Phone:503-949-4961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1935103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical