Provider Demographics
NPI:1497299861
Name:DR. TEGAN BARSON, INC.
Entity type:Organization
Organization Name:DR. TEGAN BARSON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:516-429-5178
Mailing Address - Street 1:55 MIDDLEBURG LN
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 MIDDLEBURY LN
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:516-429-5178
Practice Address - Fax:617-706-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10369103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty