Healthcare Provider Details

I. General information

NPI: 1750313185
Provider Name (Legal Business Name): MARY C BARBATO CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY C DONNELLY CNS

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MYRON ST SUITE A
WEST SPRINGFIELD MA
01089-1598
US

IV. Provider business mailing address

50 STOW ST
WALTHAM MA
02453-1613
US

V. Phone/Fax

Practice location:
  • Phone: 413-592-1980
  • Fax: 413-439-0096
Mailing address:
  • Phone: 508-790-1925
  • Fax: 508-790-1925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number150905
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN150905
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: