MEDICARE: DR. BARRY JAY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6301002993	MI

General Provider Information

NPI Number	:	1447229638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY JAY PH.D.

Provider Business Mailing Address
First Line	:	6022 W MAPLE RD
Second Line	:	SUITE 414
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4408
Country	:	US
Telephone Number	:	248-626-8889
Fax Number	:	248-366-1146

Provider Business Practice Location Address
First Line	:	6022 W MAPLE RD
Second Line	:	SUITE 414
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4408
Country	:	US
Telephone Number	:	248-626-8889
Fax Number	:	248-366-1146

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	07/08/2007

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