Healthcare Provider Details

I. General information

NPI: 1104721331
Provider Name (Legal Business Name): REGINA MANE BARRETT C-IAYT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GINA M BARRETT

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 SHELBURNE FALLS RD.
CONWAY MA
01341
US

IV. Provider business mailing address

2701 SHELBURNE FALLS RD.
CONWAY MA
01341
US

V. Phone/Fax

Practice location:
  • Phone: 207-632-6698
  • Fax:
Mailing address:
  • Phone: 207-632-6698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: