Provider Demographics
NPI:1649702374
Name:MACTAVIOUS, BARBARA
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:
Last Name:MACTAVIOUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BARBRAA
Other - Middle Name:
Other - Last Name:BLYDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:BARBEL PLAZA SOUTH
Mailing Address - Street 2:THE ROSS BUILDING, FIRST FLOOR
Mailing Address - City:ST. THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802
Mailing Address - Country:US
Mailing Address - Phone:340-774-7700
Mailing Address - Fax:340-774-4701
Practice Address - Street 1:BARBEL PLAZA SOUTH
Practice Address - Street 2:THE ROSS BUILDING, FIRST FLOOR
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-774-7700
Practice Address - Fax:340-774-4701
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health