Healthcare Provider Details

I. General information

NPI: 1922033703
Provider Name (Legal Business Name): BRENDA J BARRY M.S., C.G.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KS 359 330 BROOKLINE AVENUE
BOSTON MA
02215
US

IV. Provider business mailing address

254 ASH ST
WALTHAM MA
02453-5803
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-3356
  • Fax:
Mailing address:
  • Phone: 508-944-5665
  • Fax: 617-667-1551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: