Provider Demographics
NPI:1780911990
Name:BARNES, SUSIE A
Entity type:Individual
Prefix:MS
First Name:SUSIE
Middle Name:A
Last Name:BARNES
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 1:83 CARLETON ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102
Mailing Address - Country:US
Mailing Address - Phone:207-699-2622
Mailing Address - Fax:
Practice Address - Street 1:1 CITY CTR
Practice Address - Street 2:THE BAY CLUB
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-6420
Practice Address - Country:US
Practice Address - Phone:207-699-2622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT3590174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist