Provider Demographics
NPI:1073588133
Name:BARNES, CELENE J (PSYD)
Entity type:Individual
Prefix:
First Name:CELENE
Middle Name:J
Last Name:BARNES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:CELENE
Other - Middle Name:J
Other - Last Name:PRIFTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:60 MAIN ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-2720
Mailing Address - Country:US
Mailing Address - Phone:603-718-9148
Mailing Address - Fax:603-782-0321
Practice Address - Street 1:60 MAIN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-2720
Practice Address - Country:US
Practice Address - Phone:603-718-9148
Practice Address - Fax:603-782-0321
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8222103TC0700X
NH1219103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW51286Medicare ID - Type Unspecified
Q23006Medicare UPIN