Provider Demographics
NPI:1396811964
Name:BARTH, ELETTRA
Entity type:Individual
Prefix:
First Name:ELETTRA
Middle Name:
Last Name:BARTH
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 1:392 11TH ST
Mailing Address - Street 2:APT 6B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4031
Mailing Address - Country:US
Mailing Address - Phone:718-832-2155
Mailing Address - Fax:718-630-3763
Practice Address - Street 1:392 11TH ST
Practice Address - Street 2:APT 6B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4031
Practice Address - Country:US
Practice Address - Phone:718-832-2155
Practice Address - Fax:718-630-3763
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000198102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst