Healthcare Provider Details

I. General information

NPI: 1417918368
Provider Name (Legal Business Name): BARRY M SHEAR PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 VALPARAISO ST
VALPARAISO IN
46383
US

IV. Provider business mailing address

2004 VALPARAISO ST
VALPARAISO IN
46383
US

V. Phone/Fax

Practice location:
  • Phone: 219-464-1089
  • Fax: 219-464-7234
Mailing address:
  • Phone: 219-464-1089
  • Fax: 219-464-7234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20040363
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: