Provider Demographics
NPI:1902084379
Name:MONA R. BARBERA, PH.D.
Entity Type:Organization
Organization Name:MONA R. BARBERA, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BARBERA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:401-272-2029
Mailing Address - Street 1:341 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-1143
Mailing Address - Country:US
Mailing Address - Phone:401-272-2029
Mailing Address - Fax:866-575-1707
Practice Address - Street 1:341 BROADWAY
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-1143
Practice Address - Country:US
Practice Address - Phone:401-272-2029
Practice Address - Fax:866-575-1707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00735103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysisGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW05143Medicare PIN