Provider Demographics
NPI:1750010393
Name:BARRY, JESSICA-LYN
Entity type:Individual
Prefix:
First Name:JESSICA-LYN
Middle Name:
Last Name:BARRY
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 1:91 TULIP AVE APT HC 4
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-1977
Mailing Address - Country:US
Mailing Address - Phone:516-526-7088
Mailing Address - Fax:
Practice Address - Street 1:229 LAUREL RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-1118
Practice Address - Country:US
Practice Address - Phone:631-489-7088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002207-01103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst