Healthcare Provider Details

I. General information

NPI: 1245964097
Provider Name (Legal Business Name): ABBY BOUVIER BARNES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1156 COOK ST
DANNEMORA NY
12929-7703
US

IV. Provider business mailing address

1156 COOK ST
DANNEMORA NY
12929-7703
US

V. Phone/Fax

Practice location:
  • Phone: 518-492-2511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number016807
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: