Provider Demographics
NPI:1649692120
Name:BARBOSA, ANNETTE MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:MARIE
Last Name:BARBOSA
Suffix:
Gender:F
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:URBANIZACION LAGOS DE PLATA
Mailing Address - Street 2:A4 CALLE 5
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-632-5282
Mailing Address - Fax:
Practice Address - Street 1:A4 CALLE 5
Practice Address - Street 2:URB LAGOS DE PLATA
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3213
Practice Address - Country:US
Practice Address - Phone:787-632-5282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5392103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical