Provider Demographics
NPI:1669734810
Name:BARR, MARISA STACY (MSED)
Entity type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:STACY
Last Name:BARR
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3912 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6704
Mailing Address - Country:US
Mailing Address - Phone:718-637-1238
Mailing Address - Fax:
Practice Address - Street 1:3912 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6704
Practice Address - Country:US
Practice Address - Phone:718-637-1238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist