Healthcare Provider Details

I. General information

NPI: 1417933607
Provider Name (Legal Business Name): KRISTEN ELIZABETH BARRY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. KRIS EG BARRY

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 01/18/2025
Certification Date: 01/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 STATE ST STE 6
BANGOR ME
04401-5343
US

IV. Provider business mailing address

109 STATE ST STE 6
BANGOR ME
04401-5343
US

V. Phone/Fax

Practice location:
  • Phone: 530-925-4673
  • Fax:
Mailing address:
  • Phone: 530-925-4673
  • Fax: 207-573-7639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1616
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 20144
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: