MEDICARE: MANDY BARRY

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1932629961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDY BARRY

Provider Business Mailing Address
First Line	:	6 STRATHMORE RD
Second Line	:
City	:	NATICK
State	:	MA
Zip	:	01760-2419
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	76 ACCORD PARK DR
Second Line	:
City	:	NORWELL
State	:	MA
Zip	:	02061-1606
Country	:	US
Telephone Number	:	508-650-5940
Fax Number	:

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

Provider Enumeration Date	:	06/21/2017
Last Update Date	:	03/25/2018

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