Provider Demographics
NPI:1720511470
Name:BARNEY, MARYSHA
Entity Type:Individual
Prefix:
First Name:MARYSHA
Middle Name:
Last Name:BARNEY
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 1:1663 MISSION ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2485
Mailing Address - Country:US
Mailing Address - Phone:877-264-6747
Mailing Address - Fax:877-539-7730
Practice Address - Street 1:121 PAUL DR STE B
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2047
Practice Address - Country:US
Practice Address - Phone:877-264-6747
Practice Address - Fax:877-539-7730
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-17-7696106E00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst