Provider Demographics
NPI:1144636739
Name:BARR, SEBASTIAN M (PHD)
Entity type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:M
Last Name:BARR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 MASSACHUSETTS AVE #390299
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1721
Mailing Address - Country:US
Mailing Address - Phone:617-299-6263
Mailing Address - Fax:
Practice Address - Street 1:56 PORTSMOUTH ST # 2
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-1328
Practice Address - Country:US
Practice Address - Phone:704-651-2997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103TH0100X
KS02994103T00000X
MA1609-PY-PR-TEMP103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service