Provider Demographics
NPI:1356877039
Name:MELTZER, BARRY
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:MELTZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CHRISTY DR
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1812
Mailing Address - Country:US
Mailing Address - Phone:781-447-6425
Mailing Address - Fax:781-447-1786
Practice Address - Street 1:10 CHRISTY DR
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1812
Practice Address - Country:US
Practice Address - Phone:781-447-6425
Practice Address - Fax:781-447-1786
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12151101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health