Provider Demographics
NPI:1588557235
Name:BARUA, POORNA
Entity type:Individual
Prefix:
First Name:POORNA
Middle Name:
Last Name:BARUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26110 WARNER AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-3979
Mailing Address - Country:US
Mailing Address - Phone:313-419-5156
Mailing Address - Fax:
Practice Address - Street 1:26110 WARNER AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-3979
Practice Address - Country:US
Practice Address - Phone:313-419-5156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician