Healthcare Provider Details

I. General information

NPI: 1396811964
Provider Name (Legal Business Name): ELETTRA BARTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

392 11TH ST APT 6B
BROOKLYN NY
11215-4031
US

IV. Provider business mailing address

392 11TH ST APT 6B
BROOKLYN NY
11215-4031
US

V. Phone/Fax

Practice location:
  • Phone: 718-832-2155
  • Fax: 718-630-3763
Mailing address:
  • Phone: 718-832-2155
  • Fax: 718-630-3763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number000198
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: