Healthcare Provider Details

I. General information

NPI: 1023028123
Provider Name (Legal Business Name): BARBARA L NILES PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 05/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HUNTINGTON AVE VA BOSTON HEALTHCARE SYSTEM
BOSTON MA
02130-4817
US

IV. Provider business mailing address

150 S HUNTINGTON AVE VA BOSTON HEALTHCARE SYSTEM
BOSTON MA
02130-4817
US

V. Phone/Fax

Practice location:
  • Phone: 857-364-4128
  • Fax: 857-364-4501
Mailing address:
  • Phone: 857-364-4128
  • Fax: 857-364-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6720
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number6720
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6720
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6720
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number6720
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: