Provider Demographics
NPI:1700903978
Name:ACKSEN, BARBARA ANN (PHD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:ACKSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 GREEN STREET
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719
Mailing Address - Country:US
Mailing Address - Phone:508-997-3881
Mailing Address - Fax:508-997-3881
Practice Address - Street 1:91 GREEN STREET
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719
Practice Address - Country:US
Practice Address - Phone:508-997-3881
Practice Address - Fax:508-997-3881
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPSY2655103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW02903OtherBLUE CROSS BLUE SHIELD
MAW02903Medicare ID - Type Unspecified