1649348715 NPI number — GREGORY JAMES BARABINO BA, MHPP

Table of content: GREGORY JAMES BARABINO BA, MHPP (NPI 1649348715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649348715 NPI number — GREGORY JAMES BARABINO BA, MHPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARABINO
Provider First Name:
GREGORY
Provider Middle Name:
JAMES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BA, MHPP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649348715
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 S SHACKLEFORD RD
Provider Second Line Business Mailing Address:
SUITE 217
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72211-3522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-221-1843
Provider Business Mailing Address Fax Number:
501-221-2376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1109 BURMAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72076-4386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-982-7515
Provider Business Practice Location Address Fax Number:
501-982-7510
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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